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ON 



STEKILITY 



MALE AND FEMALE, 



ITS 



CAUSES AND TREATMENT. 

BY THE CHEVALIER V." MONDAT, D. M. P., 

PROFESSOR OF ANATOMY, AND DISEASES OF WOMEN AND CHILDREN — MEMBER 
OF THE ROYAL ACADEMY OF MEDICINE, ETC., ETC. 



TRANSLATED FROM THE FIFTH FRENCH EDITION. 



WITH FIFTY ILLUSTRATIONS. 



NEW YORK: 
J. S. REDFIELD, CLINTON HALL. ^^'^^ 

BOSTON: SAXTON, PEIRCE, & CO. ""^ 

1844. 



1 



■J^ 



Entered, according to Act of Congress, in the year 1844, 
By J. S. REDFIELD, 

in the Clerk's Office of the District Court of the United States, for the Southern 
District of New York. 



STEREOTYPED BY REDFIELD & SAVAGE. 
13 CHAMBERS STREET, N. Y. 



'7 



AMERICAN PREFACE. 

No greater misfortune can, generally speaking, be 
entailed upon a married couple, than that of Sterility. 
The absence of offspring seems, at once, to defeat the 
ends and aim of the matrimonial compact, and often 
embitters a connection, which, if attended with a 
family of children, would be one of great happiness. 
The subject is a cause of constant and mutual re- 
crimination between the husband and wife. Under 
these circumstances, the confidential medical adviser 
of the family is consulted ; but as this is a subject 
to which little attention has usually been paid, and 
as there is no professional treatise upon it, but little 
light can be thrown by him upon the causes, nature, 
and treatment, of this malady. 

Under these circumstances, it has been deemed 
expedient to publish a translation of the work of the 
distinguished Chevalier V. Mondat, who has received 
marks of distinction from several of the learned socie- 
ties of France, as an extremely eminent and scientific 
practitioner ; for the last twenty years, he has 
devoted the best energies of a highly cultivated mind 



4 AMERICAN PREFACE. 

to deep research upon this obscure and difficult sub- 
ject, and with immense success. His book has 
passed through five large editions ; and the translation 
of it, now first presented to the medical profession, 
will justify any expectations which may have been 
formed in regard to its merits. It is, in fact, a com- 
plete work on Sterility, examined in all its bearings. 
It likewise introduces to the notice of the profession 
a new instrument, the Congester^ which is founded on 
highly scientific principles, and has produced valuable 
results. 

We bespeak for the book as favorable a reception 
in America, as it has received in France. 



PREFACE 

TO THE 

FIFTH FRENCH EDITION. 

The interest manifested by the public in the early 
editions of this work, and its unexpected success, 
have imposed new obligations on me. Medical science 
has advanced so rapidly, that I have made unusual 
efforts to bring this book up to the level of the 
present state of our knowledge, and to adduce, ia 
this present edition, the results of my late observa- 
tions, and of the remedies used in these latter times. 

The additions and alterations made in this fifth 
edition, are to be found principally in the chapters 
devoted to the causes and treatment of sterility, more 
particularly in regard to the new instruments and 
medicines, which experience has proved to be very 
efficient in the treatment of this malady. The diffi- 
culties attending the subject leave much to be desired ; 
but we have attempted to fulfil our task conscien- 
tiously, and, we hope, to the farther satisfaction of 
the public. 

V. MoNDAT, D. M* p. 

Paris, ] 843. 



LIST OF ILLUSTRATIONS. 

No. Page. 

1. Section of Penis 16 

2. Urethra 17 

3. Corpus Cavernosum 18 

4. Structure of Testes 21 

6. Body of Testes 21 

6. Vas Deferens. 21 

7. Inner Surface of Bladder 24 

8. Muscles of Perineum 25 

9. Vesiculae Seminales 28 

10. Section of Pelvis 30 

11. Hymen 31 

12. Ovary 31 

13. Section of Uterus 34 

14. Uterus 35 

15. Relations of Uterus with Bladder 36 

16. Natural State of Os Tincce 37 

17. Os Tincoe at third Month of Pregnancy 37 

18. Os Tincoe at sixth Month 37 

19. Seminal Animalcales * 40 

20. Mai-Direction of Penis 54 

21. Phymosis 78 

22. Paraphymosis 79 

23. Congester 93 

24. Operation for Circumcision 96 

25. Hydrocele seen Externally 115 

26. Hydrocele seen Internally 115 

27. Vasa Deferentia Diseased 117 

28. Bivalve Speculum 173 

29. Uterine Sounds 189 

30. Natural State of Uterus 193 

31. Partial Descent of Uterus 193 

32. Complete Descent of Uterus 193 



INTRODUCTION. 

The generation of men and animals, termed by the 
immortal Bichat the third life, or order of functions 
of our economy, is a phenomenon as great as that of 
the motions of the earth or stars; but everyone is 
familiar with this prodigy of nature, and it does not 
astonish. And the growth of vegetation around us, 
and the perpetuity of the human species, are regarded 
in the same light. If men ardently desire to leave 
posterity after them, and to have children, they simply 
exercise the mysterious function of reproduction, and 
never seek to study the phenomena which have caused 
it. 

Many naturalists, philosophers, and medical men, 
however, have examined with zeal and perseverance 
the process of generation. Time and reflection have 
brought to light many valuable physiological discov- 
eries. The depths of nature have been to a certain 
degree sounded and explored : and now nearly the 
same is known of the important function of reproduc- 
tion, as of the other physiological functions. The 
writings of Velpeau, and the learned and logical com- 
munications of Dr. Jolly, in his Dictionary of Medi- 



10 INTRODUCTION. 

cine, have thrown much light on this part of science ; 
and I here return to them my sincere gratitude for the 
instruction and aid in preparing this, the fifth edition 
of my book. 

Every animal receives with its existence the power 
of perpetuating its species ; but many causes, arising 
from the conditions of the organization, or dependant 
on circumstances, may modify or change the laws 
which govern the different phenomena of reproduction. 
It seems that nature does not subject this important 
function to the intellectual powers. At least, this is 
the case in the human species, where although the 
congress of the sexes occurs at all periods and sea- 
sons, generation is less frequent, from the fact that it 
is more subject to social compacts and institutions. 
And perhaps the number of sterile marriages observed 
in the large cities may be referred to this cause, while 
the families of farmers increase rapidly. In the coun- 
try, the secret dictates of the heart are followed with- 
out so much regard to interest ; in the city, on the 
contrary, at least in the old world, most marriages are 
decided by ambition, the necessity of luxury, the 
equality of rank, fortune, and station. 

We shall, however, content ourselves here with this 
simple remark as to the fact, and leave its considera- 
tion to moralists and statesmen, as Plutarch, Montes- 
quieu, Buffon, Cuvier, &c. We shall point out par- 
ticularly the causes of sterility, which belong espe- 
cially to art. I allude to the different morbid circum- 



INTRODUCTION. 11 

Stances which may exercise an influence on the phe- 
nomena of reproduction. 

A function which transmits vitality must contain in 
itself the cause of its destruction : consequently the 
instruments intrusted with the perpetuation of the 
races and species, may become the necessary cause of 
their end. In other words, the causes of sterility, as 
of fecundity, are situated in the organs destined for 
this purpose. Hence it is important to study them in 
their anatomical and physiological conditions, to deter- 
mine the part they exercise in the sexual relations, and 
that which they take in the accomplishment of genera- 
tion. The acts which compose this function are so 
numerous and complex, that the great number of 
organs which contribute to it is not astonishing. 

As the genital organs participate in the different 
diseases which affect the human species, they may be 
nullified by any morbid state, in the same manner as 
every other function may be suspended by the lesion 
of the organs which perform it. Nature, however, 
which seems to have enveloped the phenomenon of 
reproduction in the most obscure mystery, has thrown 
the same obscurity around the diseases of the genital 
system. It is, however, only by studying sterility in 
this point of view, that the physician can promise suc- 
cess in regard to his treatment. In fact, to point out 
its causes is to define an obstruction against which 
every effort of art strives in vain : it is to have taken 
the first and greatest step toward the cure. In thus 



12 INTRODUCTION. 

referring the etiology of sterility to sterility itself, we 
should be naturally led to speak of the remedy which 
each cause of barrenness, considered in detail, may 
require. It is only by adapting medication to the 
cause of the disease, that we can expect its cure : we 
must, however, admit the insufficiency of such a 
guide in many cases, where the diagnosis of sterility 
escapes the researches of the most attentive observer, 
and where experience alone can dictate the mode of 
treatment. As we can not ascertain the degree of dis- 
ease in the organs, without a perfect knowledge of 
their healthy state, I shall glance rapidly at the ana- 
tomical and physiological history of the genital sys- 
tem. I have also thought proper to examine in this 
work, the different substances employed by art to re- 
move this kind of sterility, which is attended with a 
marked diminution of the vital properties of the geni- 
tal system ; and also to mention some formulae gener- 
ally employed in my practice. I have also introduced 
drawings of several instruments, with a view to fix the 
neck of the uterus, when from any deviation it loses 
its natural relations with the vulvo-vaginal canal dur- 
ing the performance of the genital act ; also, two new 
drawings, representing instruments to perfect the tur- 
gescence of the penis in the numerous cases where 
nature is insufficient to fulfil the function of coition ; 
they develop the virile member, and render it large 
enough to fulfil the act of reproduction. They serve 
also to render the uterus hypertrophied, by developing 



INTRODUCTION. 13 

its tissues, and to restore or excite the menstrual dis- 
charge. 

To avoid all confusion in the examination of the 
different subjects, I have thought proper to divide 
them into chapters, adopting in each the same physio- 
logical divisions. In the details, I have attempted to 
state, as briefly as possible, whatever of truth has been 
written on the subject; being careful to mention the 
precepts confirmed by experience, or generally admit- 
ted by the most trustworthy authorities. Hence, I 
have been able to enlarge the book by cases from the 
best authorities, or which have occurred in my own 
practice. Hitherto, the development of the penis has 
been regarded as beyond the resources of the art. 
Hypospadias and epispadias have been constantly re- 
garded by authors as absolute causes of impotence. 
In a former edition, I have stated the success obtained 
in the first case by the remedies there indicated ; and 
I have ventured to attack the latter disease, as will be 
seen in the proper place, by simple measures, by 
which many individuals have now become fathers, who 
were formerly regarded as incurable. I have demon- 
strated the existence of a membrane, termed the mem- 
hranous uterine sac, which absolutely prevents fecundi- 
ty. I have also avoided every digression from my 
proper subject. In fact, science does not consist in a 
vain show of hypotheses, nor in excessive erudition, 
but in the exposition of certain principles, and of 
facts strictly observed. I know the difficulty of treat- 

2 



14 INTRODUCTION. 

ing a subject of such magnitude and obscurity ; but 
having devoted myself, for many years, to diseases of 
females, and having heard of many complaints of 
sterile marriages, I have thought proper to continue to 
offer them the fruit of my meditations, and long and 
difficult researches on this subject. 

I am avv^are that this kind of book is not apt to meet 
with favor, and the critic is disposed to review^ it with 
severity; but my object in writing it is the public 
good : and with this view, I say to my book, as Hor- 
ace said to his : 

Fuge quo discedere gestis . . . 
Non erit emisso reditus tibi . . . 



STERILITY 

IN THE 

MALE AND FEMALE, AND ITS CURE, 



PART I. 

CHAPTER I. 

ANATOMICAL AND PHYSIOLOGICAL HISTORY OF THE GENITAL 
ORGANS, CONSIDERED IN BOTH SEXES. 

This third life of our organization, depending on 
the other two has special distinctions and presents pe- 
culiar phenomena. No function of the economy re- 
quires the exercise of a greater number of organs than 
the generative. The instruments of this important func- 
tion, which are arranged in a manner most favorable 
for the union of the sexes, notwithstanding their sym- 
metrical and regular arrangement, are partly indepen- 
dent of the will. Hence they have been regarded by 
many physiologists (as BufFon, Bichat, &c.,) as hav- 
ing an existence independent of the rest of the indi- 
vidual, a vitality more limited than that of the other 
organs. The manner in which they contribute to this 
function forces us to distinguish them into 4 orders : 1. 
organs of conjunction : 2. organs of secretion: 3. or- 
gans of emission : 4. organs of preservation. This di- 
vision could be modified, according to the sexes : but 



16 STERILITY CAUSES TREATMENT 

we have thought proper to preserve it, so as not to In- 
terrupt the plan of the work, especially as the descrip- 
tion of each organ is followed by that of its functions 
in the process of generation. 

In order not to exceed our limits, we shall not con- 
sider the genital organs, till after the period of puberty, 
that Is when they become ready for the process of 
generation. 



GENITAL ORGANS IN THE MALE. 

§1. ORGANS OF CONJUNCTION. 

This order of organs is composed of the penis only. 

Anatomical Arrangement. — Situated in front of the 
symphysis pubis, the penis is formed essentially of 
three parts, viz. : the corpus cavernosum, glans, and 
urethra. 

1. The corpus cavernosum presents the form of an 
elongated tube, flattened from above downward, di- 
vided internally by a median septum, which has in- 
duced some anatomists to regard it as composed of 
two distinct parts. This is seen in fig. 1 : 

[Fig. 1.3 

Z a. Urethric part of the 
penis. 
6. Glans. 
c. Dorsal vein, 
a d. The septum. 

At its anterior extremity, where it unites with the 
glans, it is single, while it is bifurcated at its posterior 
extremity, for its double insertion in the rami of the 
ischium and pubis. It is formed of an external mem- 




IN THE MALE AND FEMALE. 



17 



brane of a fibrous character, and of a spongy or cellu- 
lar tissue, which constitutes its greater portion. Its 
organization seems to be a network of small fibrous 
layers, belonging to the external membrane, of arteries 
and veins, which admit more or less blood when the 
penis is erect, and probably of nervous filaments, which 
regulate the degree of nervous sensibility in the organ. 
2. The urethra is a membranous canal extending 
from the neck of the bladder to the extremity of the 
penis, and is shown in the annexed cut (fig. 2) : 
[Fig. 2.] 



a. Bladder, or receptacle of urine. 

h. Ureters, or passages through 
which the urine comes from 
the kidneys, where it is form- 
ed, to the bladder. 

c. Vas deferens, through which the 
semen passes from the testi- 
cle, where it is formed, to the 
seminal vesicles, where it is 
matured. 

d.d. Openings of ureters into the 
bladder. 

e. Prostate gland. 

/. Orifices of excretory ducts. 

g. Openings of the seminal ducts. 

h. Ischio-cavernous muscles. 

i. Bulb of urethra divided. 

k. Cowper's glands. 

/. Wide part of urethra, 

m. Narrow part. 

n. Fossa navicularis. 

0.^. Prepuce. 




2* 



18 



STERILITY — CAUSES TREATMENT — 



It serves not only as the execretory passage for the 
semen and urine, but also assists in forming the struc- 
ture* It is situated in the lower part of the penis, 
in a kind of groove formed by the corpus cavernosura, 



as shov^n in fig. 3. 



[Fig. 3.] 




a. Corpus cavemosum. 

b. Division, or septum. 

c. Corpus spongiosum. 

d. Urethra. 

e. Great vein of the penis. 



It extends along the whole length of the penis, and 
then passes through the glans, terminating at its ex- 
tremity. It presents, in different portions of its extent, 
a different kind of organization, and hence anatomists 
have divided it into two parts — a membranous and a 
sjpongy portion. The latter is the more extensive, and 
is very analogous in structure and vitality to the corpus 
cavernosum, so that their action must be simultaneous 
in order that the erection may be perfect. 

3. The glans has a conical form, the top of which 
is perforated by the orifice of the urethra, and the base, 
divided obliquely from above downward and from 
behind forward, embraces the anterior extremity of the 



IN THE MALE AND FEMALE. 19 

corpus cavernosum. It is covered by the membrane 
of the prepuce^ more or less perfectly, according to 
the individual. Its organization is spongy, of the same 
nature as that of the urethra, and possesses its erectile 
property. 

Uses. — The uses of the penis depend on its form, 
which is one of the principal conditions of the sexual 
relations ; on its highly spongy organization, on which 
its erectile property depends ; on its exquisite and 
special sensibility, which insures its exercise, on the 
passage which passes through it, and which serves for 
the transmission of the semen. 

It is impossible to explain the phenomenon of erec- 
tion except by an afflux of heat and blood into the 
vessels of the penis (and not, as has been asserted, 
into the cellules of the corpus cavernosum and the 
spongy tissue of the urethra), under a direct or sympa- 
thetic influence. Some physiologists have, however, 
attributed it to the compression of the pubic veins, 
between the symphysis pubis and the rest of the penis, 
by the action of the levator muscles ; but Heist er, 
Senac, his translator, and Richerand, have demonstrated 
the futility of this explanation by the arrangement of 
the muscles, and have referred it more properly to the 
mode of vitality of the organ ; that is, to its erectility. 

§11. ORGANS OP SjbiCRETION. 

Under this title are included the testicles, with their 
envelopes, and their excretory ducts. 



20 STERILITY CAUSES TREATMENT 

1. Testicles. 
Anatomical Structure. — The testicles {testis^ a witness) 
have been thus termed because they constitute the 
principal distinctive characters of, and bear witness to 
virility. They are usually situated below the pubic 
region, at the inner and upper part of the thighs. 
Their form is ovoid, and they are seldom equal in size. 
They are covered with five envelopes, in the following 
order : 1. The scrotumy forming a pouch for the two, 
which is a prolongation of the cutaneous tissue. 2. 
The dartos, which is a cellular membrane peculiar to 
each gland. 3. The erythroid tunic, formed by the 
expansion of the cremaster muscle. 4. The peritoneal 
coat, which envelopes the testicle, like the serous 
membranes ; that is, without containing it in its cavity. 
5. The Jihrous coat, tunica albuginea, contiguous on 
the outside to the preceding, and on the inside to the 
parenchyma of the gland. From this inner face pro- 
ceed prolongations which go to the posterior edge of 
the testicle, forming septa or cellules, which vary in 
form, and which contain the proper substance of the 
organ. The latter is formed of a great number of 
capillary tubes, which are folded and twisted on them- 
selves. See fig. 4. They appear to arise from the 
extremities of the spermatic arteries, and go toward 
the upper edge of the testicle, anastomose and form ten 
or twelve tubes, sometimes more, which unite and con- 
stitute the corpus Hyghmorianum. These tubes then 
proceed to the upper part, through the tunica albugin- 



IN THE MALE AND FEMALE. 

[Fig. 4.] 



21 




fl. Body of the testicle. &. Tubuli testis, c. c. Rete testis, d. Vasa 
deferentia. e. Vascular cones. /. Epididymis, g. Vas deferens. 

ea, which encloses them, to unite in one duct, called 
the epididymis, thus termed because it joins the upper 
edge of the testicle. 

2. The Vas Deferens. 
The vas deferens arises from the extremity of the 
epididymis, and goes from below upward, toward the 
[Fig. 5.] 




fl. Body of the testicle, h. Commencement of the epididymis, c. End 
of ditto, d, Vas deferens. 



22 STERILITY CAUSES TREATMENT 

cord of the spermatic vessels, with which it passes 
through the inguinal ring, to descend obliquely toward 
the inside of the vesiculae seminales, into which it 
penetrates. (Its origin is seen in fig. 5.) In its course, 
it becomes manifestly flat, although its cavity is exces- 
sively narrow, and its parietes of almost cartilaginous 
density. 

Each testicle receives also an artery, the spermatic ^ 
coming directly from the aorta, or from the renal arte- 
ries, lymphatic vessels, which are not seen clearly ex- 
cept between the seminal ducts, and which give origin 
to these veins, and, finally, nerves which come from 
the lumbar plexus, but which have not yet been fol- 
lowed into the parenchyma of the testicle. 

Uses. — The testicles secrete the semen ; but the 
manner in which this function is performed, is also as 
obscure as that of the other functions in general. In 
confining ourselves to observing the most evident phe- 
nomena of this fact, we should notice the thinness and 
tortuous arrangement of the spermatic arteries. This 
anatomical arrangement causes the slowness, and the 
quantity of material for secretion in the testicles, and 
modifies their vitality. We know also that in propor- 
tion as the semen is secreted, it goes into the sinus of 
the seminal vessels, and then proceeds toward the vas 
deferens, whence it passes into the seminal vesicles. 
We know but little of the nature of this secretion, 
inasmuch as it can only be examined mixed with the 
fluids coming from the seminal vesicles, prostate 



IN THE MALE AND FEMALE. 23 

gland, and follicles of the urethra. It is in this state 
of combination, that we have studied the seminal ^ma* 
terial, as also its importance in the copulative functions. 
(See article on seminal fluid.) 

'^ III. ORGANS OF EMISSION. 

A great many parts contribute to the emission of 
the semen, either simply by fulfilling the uses of their 
structure, as the ejaculatory ducts ^ verumontanum^ canal 
of the urethra^ or by secreting the fluids designed to 
lubricate these same parts, and to serve at the same 
time as a vehicle for the seminal fluid {prostate glands 
Cowper^s glands, follicles of the urethra), or by exer 
cising on this liquid itself an expulsive action capable 
of causing its excretion {seminal vesicles, muscles). 

The ejaculatory ducts and the canal of the urethra 
as agents of transmission, and the seminal vesicles as 
contractile agents, will be described, (See organs of 
congress, p. 29, and seq.) We have now to remark 
in regard to the first, that a great number of the folli- 
cles secrete a fluid proper to lubricate them internally, 
and to favor the emission of the semen. The pros- 
tate gland which appears particularly to have this use, 
if it does not modify the properties of the semen, is sit- 
uated near the neck of the bladder and the commence- 
ment of the urethra which it supports. It is formed 
of a dense tissue, of a grayish color, in the middle of 
which are numerous foUicles, filled with a viscid and 
whitish fluid which is brought by ten or twelve excre- 



24 STERILITY— CAUSES TREATMENT 

lory passages into the urethra. The secretion of this 
fluid, seems to be increased by that from the glands of 
Cowper^ situated in front of the prostate. 

Nature, to impart to these fluids a direction favor- 
able to their emission, has placed at the commencement 
of the urethra, before the neck of the bladder, at the 
point where their excretory ducts open, a sort of dike 
{verumontanum) which is designed to prevent the re- 
turn of these fluids on the side toward the bladder, 
and is seen in the annexed cut (fig. 8). The muscles 
which, by their action, aid the excretion or projection 
of the semen are, the levatores ani, the hulbo- and ischio- 
cavernosuSi and the transversus perinei muscles. The 

[Fig. 8.T 




a. The inner surface of the bladder, showing the direction of the mus ' 
cular fibres, b. The opening of the right ureter into the bladder whence 
the urine issues, c, c. The prostate gland cut through, and its sides ex- 
hibited, d. The urethra, e. Verumontanum. fj f. Orifices of the sem« 
inal ducts, marked by twigs inserted therein j the other points mark the 
orifices from the prostate and other glands. 



IN THE MALE AND FEMALE. 



25 



first two are situated directly at the posterior and infe- 
rior part of the rectum, in the space between the rami 
of the ischium and pubis, the sacrum and the coccyx, 
and tend by their spasmodic contraction to compress the 
seminal vesicles and the prostate gland, from which 
they ai^ separated only by the lower part of the rec- 
tum. 

The bulbo cavernosus and transversus perinei mus- 
cles are situated horizontally betweeu the anus and the 

[Fig. 7.] 




1 . Point in the perinoeum where the principal muscles arise or meet, 
S. Covering tjf the thigh. 3. Seat. 4, Corpora 'cavernosa of the penis, 
5. Corpus Spongiosum. 6. Coccyx. 7. Great sacro sciatic ligament, 
a, a. Erector muscles of the penis. 6, h. Accelerator urinas muscles. 
c. Line whence the above muscles take their origin, d. Transverse mus- 
cles of the perinoeum, e, e. Sphincter muscle of the anus, supposed to 
be distended with tow or wool. /,/. Levatores ani, g, g. Great gluteal 
muscles, 

3 



26 STERILITY CAUSES TREATMENT. 

bulb of the urethra ; they also, by their convulsive ac- 
tion, compress the posterior part of the urethra, and 
thus accelerate the emission of semen, a property 
which induces Soemmering to term them the muscuU 
acceleratores. 

The ischio'Cavernosus, termed by the same author 
musculus erector, and situated between the sciatic tu- 
berosity and the corpus cavernosum, possesses an ac- 
tion which seems to belong more particularly to the 
phenomena of erection. Many of the muscles are seen 
in fig, 7. 

^IV. ORGANS OF PRESERVATION. 

Under this title we include the organs which pre- 
serve the seminal fluid, or elaborate it anew {vesiculce 
seminales), and the ejaculatory ducts which transmit 
this fluid into the canal of the urethra at the moment 
of copulation. 

Vesiculcd Seminales, 

Anatomical Arrangement. — The vesiculce seminales 
are two membranous layers separated from each other 
by the vasa deferentia, and situated obHquely between 
the rectum, the levatores ani muscles, and the bladder ; 
they are much broader at their posterior than at their 
anterior extremity, where they present a neck-shaped 
contraction terminated by a canal one or two lines 
long which is joined at an acute angle with the vas 
deferens. The parietes of the seminal vesicles are 
composed of two membranes, viz., an internal, which 



IN THE MALE AND FEMALE. 27 

seems to be a continuation of that of the vas deferens, 
and which some authors have regarded as muscular, 
on account of the contractile power with which it fa- 
vors the emission of semen during coition. The sec- 
ond membrane, which is evidently the continuation of 
the mucous membrane of the urethra, secretes a fluid 
which has every appearance of the follicular fluids, 
but its nature, quantity, and uses, are not yet well as- 
certained. The seminal vesicles receive bloodvessels 
which have no special names, nerves which are so fine 
that their course can not be followed, finally, very nu- 
merous lymphatic vessels which absorb and carry into 
the circulation the fluids which are deposited and se- 
creted in these organs, when from long-continued con- 
tinence they are not excreted. The interior of the semi- 
nal vesicles presents tortuous cells or canals separated 
by as many ridgelike appendages, like those found in 
the neck of the gall bladder, which cause the grooved 
appearance remarked externally. This structure is 
seen in the annexed cut (fig. 9). 

Uses. — It is not as easy as it is imagined to define 
the uses of the seminal vesicles. Are they the secre- 
tory organs designed solely for the work of generation, 
furnishing to the semen a particular fluid which forms 
its greater part and imparting to it the prolific qualities 
while it passes through them? or are they simply the 
reservoir for the seminal fluid, secreting always a mu- 
cous fluid designed to moisten their internal surface, 
like all the cavities provided with follicular membranes? 



28 STERILITY CAUSES TREATMENT. 

[Fig,9.] 




a, a. Prostate gland, b. Gland cut away to show the ducts of the ve- 
siculse. c. Ends of the ducts, d, d. Cells of the vesiculse. e. Left vas 
deferens, also cut open to show its connexion with the vesiculse. /. 
Right vas deferens, gj g. Openings of the vas deferens and vesiculse into 
the urethra, h. Bladder, i. Ureter. 

Swammerdam and Richerand have contested this latter 
opinion to adopt the first which experience seems 
especially to justify : in fact, it is certain that the 
physiological integrity of the seminal vesicles is no less 
indispensable to the work of generation than that of 
the testicles, which proves in every hypothesis (at least 
in the human species) the necessity of the mixture of 
the liquids which they supply, and also refutes the 
idea of some physiologists, who regard the vesicles as 
simply fulfilling the uses of position or as mechanical 
means for the transmission of the seminal fluid at the 
moment of ejaculation- 



IN THE MALE AND FEMALE. 29 

Ejaculatory Ducts. 

A7iatomical Arrangement. — The ejaculatory ducts 
which result from the union at an acute angle of the 
anterior extremity of the seminal vesicles with the vas 
deferens, pass through the prostate gland, and go sep- 
arately to the lower part of the urethra at the base of 
a lacuna called the verumontanum. 

Uses. — The use of these passages is to transmit into 
the canal of the urethra the seminal fluid, and thus to 
contribute to the act of coition. 



GENITAL ORGANS OF THE FEMALE. 

§1. ORGANS OF CONGRESS. 

The parts which compose this order of organs do 
not contribute equally to the act of reproduction; 
some are placed externally and seem to be only organs 
of pleasure, such as the clitoris, nymphae, &c. ; others 
are connected more intimately with the phenomena of 
coition, and fulfil more directly the purpose of the 
union of the sexes. Viewed in this light, the vagina 
alone seems to deserve a particular description. 

Vagina. 
Anatomical Arrangement. — This organ is situated 
in the centre of the lower strait of the pelvis between 
the rectum and bladder ; it has the form of a cylin- 
drical membranous passage slightly curved in its pos- 
terior part, and is five or six inches long. One ex- 
3* 



so STERILITY CAUSES TREATMENT. 

tremity opens at the base of the vulva, and the other 
embraces the neck of the uterus with which it is con- 
tinuous, as is seen in fig. 10. The vagina is a soft, 

[Fig. 10.] 



a. The bony portion of the pelvis separated from its junction with its 
companion, b. The spinal colunm of the back. c. The bladder, d. 
The orifice of the urethra, e. The body of the womb. /. The neck of 
the womb. g. The vagina, h. The rectum, or end of the intestines. 

supple, extensible structure, composed 1 st, of a por- 
tion of the peritoneal membrane which occupies only 
its posterior and superior part ; 2d, of a thick cellu- 
lar layer, constituting its proper membrane and occu- 
pying its whole extent ; 3d, of a spongy body placed 
at its entrance {plexis retiforme) sensibly erectile du- 
ring coition, and surrounded with muscular fibres 
which perform the ofiice of a sphincter, the constrictor 
cunni muscle ; 4th, of a mucous membrane which it 
possesses in common with that lining the whole uterine 
system, which presents corrugations especially at its an- 
terior extremity, where they conceal numerous porosi- 
ties, whence flows the mucous fluid which continually 
lubricates the interior of this passage ; 5th, of a mem- 





i 



IN THE MALE AND FEMALE. 



31 



branous and semicircular fold which contracts the en- 
trance in virgins, and is termed the hymen. It is seen 
in fig. 11. 

[Fig. 11.] 




1. Urethra. 2. Hymen. 

Uses. — The vagina (the sheath), as its name indi- 
cates, is destined to receive the penis in the act of 
coition, to give passage to the menstrual fluid, and to 
the fetus, at the time of labor. 



'I 11. ORaANS OF SECRETION* 

1. Ovaries. 
Anatomical Arrangement. — To this new order of 
organs belong the ovaries and Fallopian tubes. In con- 
sidering the ovaries as secretory organs, we are far 

[Fig, 12J 




from adopting the opinions of the ancients, and some 
moderns, who think that these organs, in the repro- 



32 STERILITY CAUSES^ TREATMENT 

ductlve process, furnish a reproductive fluid, like the 
testicles* It seems, however, reasonable to admit that 
the formation of ova or germes capable of being devel- 
oped by impregnation, is the product of a real secre- 
tion. The ovaries are situated on the sides of the 
womb, in the fold of the posterior wing of the broad 
ligaments of the uterus. They were called by the 
ancients female testes. They are two whitish vascular 
oblong bodies, which have been compared in size and 
form to those of a small pigeon egg. Each ovary has 
a peculiar membrane, a parenchymatous tissue pre- 
senting the appearance of the proper substance of the 
testicle, or of the parotid gland, seeming also to be an 
expansion of its proper substance, and even forming 
cells for the corpuscles with membranous, vascular, 
and transparent parietes. These vesicles are fifteen 
or twenty in number, and vary in size from a millet 
seed to a bean. They contain a viscid fluid, having 
all the characters of albumen. The arteries of the 
ovaries {spermatic) arise directly from the aorta, and, 
in the opinion of Haller, their size seems to corre- 
spond with the amorous nature of the female. They 
are supplied with some very small nervous twigs from 
the trisplanchnic nerve, and the lumbar and sacral 
plexuses, and lymphatic vessels, which terminate in 
the veins, or open in the lymphatic ganglions of the 
lumbar region. 

Uses. — The ovaries are absolutely necessary to gen- 
eration. Their natural absence, their removal, and 



IN THE MALE AND FEMALE. 33 

most of their diseases, which cause sterility, demon- 
strate the truth of this assertion. But it is difficult to 
determine the exact part they take in this function. 
The ancients, among whom we would cite Hippocra- 
tes and Galen, compared them to testicles, and thought 
they secreted a seminal fluid possessing the same pro- 
lific qualities as that of man. This opinion, although 
sustained by some modern physiologists (as BufFon, 
Roussel, Tinchant, &c.), is now for the most part aban- 
doned. Since the time of Stenon, who was the first 
to observe the vesicles of the ovaries, and to compare 
them to ova containing all the rudiments of the man, 
simply wanting the vis vitae furnished by the male, it 
has generally been thought that these vesicles, when 
once rendered fecund by impregnation, break the 
calyx in which they are enclosed, and pass through the 
Fallopian tubes, and thence into the uterus. 

2. Fallopian Tubes. 
Anatomical Arrangement. — The tubes are two coni- 
cal membranous passages, situated within the anterior 
wings of the broad ligaments of the uterus. One of 
their extremities is terminated in a kind of fringe, to 
adapt itself to the ovary, while the other opens by a 
very narrow orifice at the upper angle of the uterus. 
These parts are well seen in the annexed cut (fig. 11). 
The tubes are formed of two membranes, one of 
which belongs to a prolongation of the peritoneum, 
and the other is the continuation of the mucous mem- 



34 STERILITY CAUSES— TREATMENT- 

[Fig.ii; 




1. Section of the womb, upper 10 and 16. The fimbriated ex- 

part, tremity of the tube. 

2. Section of side. 11. The pavilion. 

3. Section of lateral covering. 12. The ovary. 

4. Section of lower part of womb. 13. Vesicles in ovary. 

5. Cavity of the womb. 14. Continuation of ovary. 

6. A prominence leading fi-om the 15. Ligament of ovary. 

openings of the Fallopian 17. Pavilion of right ovary, 

tubes. 18. Right ovary. 

7. The vagina. 19. Connecting band. 
8 and 9. Fallopian tube cut open. 

brane of the uterus, and of a proper tissue, which 
seems to possess some degree of erectility. 

The use of the tubes is to establish a communica- 
tion between the uterus and the ovaries; but this com- 
munication only seems to take place at the moment of 
coition, and by a kind of erection of the fimbriated 
edge, which then embraces the ovaries, and forms a 
passage which transmits from this organ to the uterus 
what the female furnishes in generation, and probably 
from the uterus to the ovary, the fecundating principle 
which comes from the male. 



§111. ORGANS OF PRESERVATION. 

Utertis. 
Anatomy. — Although our opinions differ materially 



IN THE MALE AND FEMALE. 35 

[Fig. 12.] 




from some physiologists in regard to the uterus,* we 
apply this term to that organ which furnishes to the 
product of conception the space and material neces- 
sary for its nutrition and development. Its form is 
seen in the cut above. It is situated obliquely in the 
cavity of the pelvis, between the rectum and bladder, 
as shown in the figure on the next page, where, how- 
ever, it is represented in an advanced stage of pregnan- 
cy. It is kept in place by several ligaments, and pre- 
sents nearly the form of a triangle flattened from be- 
fore backward. Its base is situated upward and back- 
ward, and is bounded laterally by two angles, which 
indicate the points of insertion of the Fallopian tubes, 
as seen in fig. 11. Its summit or neck, directed down- 
ward and forward, is embraced by the vagina, into 
which it projects for four or five lines, and is perforated 
by an oval opening, the os tincoe, which establishes a 
communication between these two organs. This os 

* Many physiologists regard the uterus, like the seminal vesicles, 
as a reservoir for preserving the seminal fluid secreted by the ovaries^ 



86 STERILITY CAUSES TREATMENT 



[Fig. 13.] 




a. The womb, h The vagina, c. The bladder, d. The rectum. 

tincoe varies at different periods of pregnancy, as is 
seen in the cut on the next page. 

The uterus is composed : 1, of a serous menn- 
brane, which serves as an external envelope in the 
whole of its extent, except at the lowest part of its 
posterior face ; 2, of a peculiar grayish dense and 
elastic tissue, presenting many bloodvessels, and the 
nature of which is not yet ascertained ; 3, of an in- 
ternal membrane, having all the characters of mucous 
membranes, presenting a great many porosities which 
have been regarded as the excretory vessels of the 
mucous crypts, and the orifices of the bloodvessels, 



IN THE MALE AND FEMALE. 

[Fig. 14.] 



37 





which exude drops of blood within the uterus at the 
menstrual period ; 4, of arteries and veins, which 
come from the hypo-gastric ; of lymphatic vessels, 
which attend them ; of nerves, which arise from the 
renal plexuses and inferior mesenteric, from the inter- 
costal and sacral nerves. 

Uses, — The uterus, as its name indicates, is des- 
tined to preserve the fecundated germe during the pe- 
riod of its development, that is, during pregnancy. 



GENERATION. 

Having described separately in both sexes, the in- 
struments of generation, and made known their pecu- 
liar functions, it remains to consider the part taken by 
each sex in the accomplishment of this function ; but 
to avoid falling into new errors on so obscure a sub- 

4 



38 STERILITY CAUSES TREATMENT— 

ject, and about which physiologists and naturalists 
have differed so much, we shall state as briefly as pos- 
sible the different theories upon this subject, and give 
to each its just value. 

All the views hitherto set forth to explain the phe- 
nomena of reproduction may be reduced to two prin- 
cipal heads ; the first, which belongs to the ancients, 
is founded essentially on the existence of a seminal 
fluid in each sex, and on their mixture in the uterine 
cavity to form the new individual. Hippocrates {de 
Geniturd), who seems to be the author of this system, 
admitted a generative faculty which regulates this kind 
of formation, and believed also that the strong parts 
of the male and female seminal fluids unite and form 
the differences in the sexes. This system which 
Aristotle {de Generat, animal.) and Descartes {Traite 
de Vhomme) have modified only by substituting for the 
generative faculty of Hippocrates their fermenting 
principle, still has many partisans. Buffon {Natural 
History) has embellished it with all the charms of his 
eloquence, and admits, with the father of medicine, that 
in each sex, the semen comes from all parts of the 
body ; and he thinks that the molecules which consti- 
tute it are so many rudiments of our organs which are 
placed by a kind of vital attraction around a mould the 
existence of which he admits. Doctor Roussel {Sys- 
teme physioL et mor. de la Femme) opposes the system 
of Buffon violently, and restores to the system of Hip- 
pocrates all its simplicity, and is one of those who has 



IN THE MALE ANB FEMALE* 39 

defended the latter most earnestly. Still more recently 
a physician* has attempted to bring it forward on cer- 
tain facts which seem to invalidate the objections made 
to it by Haller and Bonnet. Without attempting to 
lay down all the reasons which can be urged against 
this system, we will simply mention as circumstances 
which have been observed : 1. That the organic tex- 
ture of the ovaries presents no analogy with that of the 
testicles, nor even with those of any glandular organs. 
2. That the arrangement of the tubes does not repre- 
sent an excretory canal since there can be no com- 
munication with the ovaries except at the time of con- 
ception ; which must destroy all ideas of the seminal 
fluid in the female. 3. That even with the hypothesis 
of the secretion of a fluid peculiar to the female, the 
fluids which come from her present none of the physi- 
cal and chemical characters of the seminal fluid in the 
male ; they can not be considered as essential to fe- 
cundation, since females conceive without emission, 
and often even without the slightest sensation of plea-^ 
sure. 4. That the fruit of the conception observed in 
the ovary and the tubes at its first development does 
not exist in the uterus before the second week ensuing 
to copulation. 

The second system, or that of the ovarists, admits 
the pre-existenceof germes in the ovary, and is founded 
principally on the analogy of structure of this organ 
in the females of oviparous and viviparous animals. 

* Tinchant, Doct. novo sur la product de I'horame. 



40 



STERILITY CAUSES TREATMENT 



Steno {Diss, pisciuin), Malpighi {de Gene?', pull, in 
ovo.)^ Harvey {de Genet, ovi.)^ Vallisniery {de Genit. 
animal.), Haller {Physiology), and Bonnet {Sepul- 
chret. anet.), who have adopted it, regard the vesicles 
in the ovaries as so many ova, which contain all the 
lineaments of the new being, and which require only 
the contact of the semen to receive life. Bonnet 
thinks that these germes pre-existed in the ovaries since 
the commencement of the world, boxed in one within 
another, and developing themselves successively by 
the effect of generation ; but this opinion which finds 
but few partisans except in the Italian schools, is now 
nearly abandoned. 

Some naturalists have also thought they found in 
the male semen animalcules, such as are seen in the 
cut (fig. 13), which by their development might be- 

[Fig. 13.] 




1. Animalcules of a man, taken from the vas deferens immediatelj 
after death. 2. Seminal granules. 3. A bundle of animalcules as group- 
ed together in the testicle. 4. Seminal globule. 6. Same surrounded by 
a cyst or bag. 



IN THE MALE AND FEMALE. 41 

come beings similar to those producing them. Leu- 
wenhoeck {Anat. epistol. varioe.), Boerrhaave {Physi- 
ology)^ GeofFroy {Moiistroskies)^ Lieutaud ( Traite 
d'anat.), &c., who have advanced this idea, think that 
the vesicles of the ovaries are only the envelope or 
the nest of the ovum, which must receive that of the 
animalcules victorious in the strife established between 
them at the moment of the reproductive act. But this 
opinion, which is as improbable as that of the hexing 
njp, has but few partisans. 

Throwing aside these last two hypotheses, it is cer- 
tain that the system of the ovarists combines in its favor 
the most votes and the greatest probabilities. It is 
more in accordance with the organic arrangement of 
the parts, and also with the laws of physiology. It is 
true the man here co-operates in generation only in a 
secondary manner, that is, by furnishing only the 
principle which must animate the germes secreted by 
the ovaries; and farther, it is difficult to explain, ac- 
cording to this system, the resemblance of the children 
to their fathers, the inheritance of disease, &c. The 
physiologist Richerand, however, remarks : '' The im- 
perceptible embryo has at most the consistence of a 
slightly viscid glue. A body so slightly consistent 
must be at least very susceptible, and the male semen 
applied to its surface must produce a powerful effect 
on it. The action of this fluid on the youthful embryo 
is similar to that made by a seal on soft wax which 
preserves its impression. The impression is deeper^ 

4* 



42 STERILITY CAUSES TREATMENT— 

the resemblance more perfect, the more energetic the 
action of the male." If this explanation be untrue, 
we must admit that it is plausible and probable ; the 
instance of hybrids, or of animals belonging to differ- 
ent species, testifies in its favor by the resemblance of 
the male externally, and by that of the female inter- 
nally. 

Of the Seminal Fluid. 

The semen is secreted, as is well known, by the 
testicles, and the species is regenerated by this fluid. 
It not only repairs the losses of generation, but it also 
procures physical sensations which command impera- 
tively the approximation of the two sexes. In all ani- 
mals we have already stated that this material goes into 
the sinuses of the seminal vessels, to proceed thence 
toward the vasa deferentia, which transmit it into the 
seminal vesicles. This fluid is a spirit, which is termed 
the aura seminalis^ as we shall show. 

Let us premise that no passage in the human econ- 
omy presents a more compact or denser tissue, nor a 
narrower diameter than that of the vas deferens. It is 
difiicult to pass into it a fine bristle. The Fallopian 
tube has a diameter nearly three times as large. This 
organization aids us to conclude that the seminal aura 
is transmitted without mixture in the seminal vesicles. 
Let us examine this assertion and its consequences. 

The human semen enclosed in the seminal vesicles 
has lost its primitive purity by its aggregation with the 



IN THE MALE AND FEMALE. 43 

fluids of the seminal vesicles. After its emission, a 
new aggregation takes place with the viscid matters of 
the prostate gland and urethra. In this state it is 
emitted, and while its heat is preserved, it should be 
analyzed. It is positively formed of three very dis- 
tinct parts : one fluid grayish white and viscid, anoth- 
er thick and whitish, and the third part appears as a 
colorless and almost invisible vapor ; it is sometimes 
so subtle, so highly volatile, that it can not be appre- 
ciated except by the special and peculiar odor it ex- 
hales, and which has been compared to that arising 
from several vegetables, especially chestnuts. For 
this reason, it has been termed the seminal aura. The 
semen has a taste more or less saltish, according to the 
quantity of the seminal aura and the vigor of the 
patient. Some authors have asserted that this part of 
the semen is the only part which went toward the ori- 
fice of the uterus, and produced impregnation. The 
following experiments seem to justify this opinion. 
In 1808, being attached to the medical staff of the 
Princess Pauline, M. Morsaqui, a learned and modest 
naturalist of Turin, wished me, together with M. Prin- 
seteau, to witness the repetition of his experiments on 
generation. The semen of a dog was received in the 
broad part of a kind of curved tunnel about two inches 
long, the other end of which was cylindrical and ex- 
tended two or three inches into the vagina of a slut in 
heat, so that the seminal aura might be introduced. 
In thirty experiments strictly noted, eighteen sluts con- 



44 STERILITY CAUSES TREATMENT 

celved. We obtained the same results on two asses, 
bat after many attempts, on account of the unruliness 
of the stallion which served for our experiments. We 
have observed in these different cases, that when the 
semen has been exposed to the air for some time, it 
would become less prolific, and would even lose its 
fecundating principle. Only one slut was impregnated 
with semen which had been exposed five minutes to 
the air. Sometimes too when a longer tube has beea 
used, conception did not occur. 

It follows from other facts, that the seminal aura 
ought to remain a certain time in the seminal vesicles, 
to experience there certain changes, and become pro- 
lific. On the other hand also, the semen, to be pro- 
ductive, ought not to remain too long in its reser- 
voirs. Persons who indulge too frequently in sexual 
intercourse, finally emit only a viscid fluid, without the 
special odor which announces the presence of the 
seminal aura, and which is consequently unfit for fec- 
undation ; while again, others who live a life of celib- 
acy, or of prolonged continence, lose a great part of 
the seminal aura, which by the subtle essence of which 
it is formed, always tends to escape and to leave the 
viscid and mucous parts which serve as a vehicle for it. 

I have often been consulted to remedy prolific dis- 
charges in perfectly formed individuals, in whom the 
semen resembled that of eunuchs who were castrated 
some years after puberty. The semen acquired its 



IN THE MALE AND FEMALE. 45 

prolific quality only after a methodical course of treat- 
ment, as we shall see in the course of this work. 

I must remark here that in Turkey and other coun- 
tries of the Levant, I have often had occasion to 
examine this fluid passed by eunuchs, in whom the 
erectility of the virile organ has been preserved ; it 
was colorless and tasteless, and had the consistence of 
a more or less thick and ashy white glue. Some of 
these individuals were very amorous, and presented 
symptoms of consumption when they abused them- 
selves ; they died from excess in coition or masturba- 
tion. I was acquainted with Velutti, a celebrated 
singer, who was castrated at an early age by his father, 
an Italian singer, in order to obtain for him a place in 
the Pope's chapel. He kept his mistress, in London, 
and injured his health by his intercourse with her. 
Look too at those females who conceive contrary to 
the wishes of their husbands, and also those who 
attempt to frustrate nature. The instances of preg- 
nancy with concubines related by authors, as Plem- 
puis, de Graaf, Johnson, are also proofs in favor of 
this opinion : whence we conclude that the seminal 
aura is the vivifying spirit, while the other fluids are 
only its vehicles. 

The effects of the seminal fluid act with so much 
force on most of our organic or relative functions, that 
we can compare them in some circumstances to an 
imperious power which rules despotically over all the 



46 STERILITY CAUSES TREATMENT 

actions of our organization. The brute, as well as 
the rational being, is subject to it. 

See the proud stallion, who comes forth from his 
stable, rearing, and plunging, and neighing. His 
organ of smell directs him to the mare, his breath 
seems to burn, while a hot fever consumes him. His 
passion is satiated, and all these phenomena disappear ; 
he becomes sad, he walks slowly with his head down, 
and allows himself to be led by a child. So too with 
a man who has exercised the procreative faculty — he 
needs repose and sleep to restore and re-establish the 
harmony of his physiological functions. Venette says, 
and with reason, that of all animals man is the most 
exhausted by the reproductive functions. One 
emission of semen causes more exhaustion, accord- 
ing to Avicenna, than the loss of forty times as much 
blood. 

Is it necessary to refer even briefly to the opinion of 
some ancient philosophers, who regarded the spermatic 
fluid as material and spiritual, as coming directly from 
the soul? The most remarkable of these philoso- 
phers were Epicurus, Socrates, and Aristotle. Plato 
considered this fluid as secreted by the spinal marrow. 
Pythagoras viewed it as coming from the froth of the 
blood. Finally, Democritus and Hippocrates regarded 
it as coming from the whole animal economy. Our 
space forbids us to mention all the hypotheses or rev- 
eries of men at all periods, who have attempted to 
explain the origin and phenomena of this fluid. 



m i 



IN THE MALE AND FEMALE. 47 

Of the Copulative Functions. 

The functions of reproduction consist in the union 
of the different sexual parts as follow. 

The organs destined to fulfil this act, must be prop- 
erly prepared : on one side by the erection of the 
male organ, in which the vessels of the two corposa 
cavernosa and of the spongy tissue of the urethra are 
filled with blood, while on the other hand the other 
parts which compose the genital apparatus, contribute 
powerfully to the reproductive process, by the follow- 
ing action : the seminal vesicles, stimulated by the 
presence of the prolific fluid, contract by virtue of the 
contractile properties of their tissues, and compress 
on all sides the fluids they contain. The levatores ani 
muscles are convulsed at the same time by the sympa- 
thetic effect of the venereal orgasm, exercise on these 
fluids the same pressure, and thus force them to enter 
into the ejaculatory ducts, through which they pass 
and come into the lower part of the urethra, near the 
verumontanum. The prostate gland, compressed by 
the adjacent parts, or closing by their peculiar contrac- 
tile force, pours into the urethra near the orifice of the 
ejaculatory ducts a limpid, viscid fluid, which is min- 
gled with the seminal fluid. The presence of these 
united fluids in the lower part of the urethra causes a 
dilatation and a voluptuous sensation, which soon ex- 
cite the contraction of the bulbo-cavernosus and trans- 
versus perinei muscles, which in turn press the semen 
contained in the canal of the urethra, and force its 



48 STERILITY CAUSES TREATMENT 

expulsion in the form of jets. The genital system of 
the female, excited by desire, under the influence of 
the blood which enters all the tissues, is convulsed by 
the numerous nervous filaments, which are expanded 
in all its parts. 

The organs thus prepared, the penis enters the vul- 
vo-vaglnal canal in a proper position. All the genital 
organs then exercise simultaneously and reciprocally a 
special labor, which causes in man the emission of the 
seminal fluid, in the manner we have explained, which 
is thrown with force on the uterine orifice ; and in the 
female, the emission of the mucous substances secreted 
by the glands situated more particularly around the 
clitoris. The whole body has participated in this con- 
vulsive effort, and it seems that all the other relative or 
organic functions have suspended their existence or 
special action to participate in that of reproduction. 
Borden remarks, *'it seems at this moment as if na- 
ture had forgotten every other function, and is occu- 
pied only in collecting its strength, and directing it to 
the same organ." 

The copulative positions should vary accoraing to 
the sexual arrangements, so as to convey the spermatic 
fluid on the orifice of the uterus. Most of them are 
indicated when treating of the lesions or faulty direc- 
tions of the genital organs. 

Organic Functions of Reproduction. 
We think that the moment the seminal fluid is 



IN THE MALE AND FEMALE. 49 

placed on the os tincoe, the uterus is unusually excited, 
and seems to expect with eagerness the food for which 
its appetite is so voracious ; while at the same time 
the fimbriated ends of the Fallopian tubes are com- 
pletely erected, and embrace the ovaries.* In fact, as 
the semen is thrown by the penis on the orifice of the 
uterus, it is received readily by a suction termed 
spermatic^ and by this special function of the neck of 
the uterus, which transmits the semen into its body, 
the seminal aura is disengaged from its vehicles, and 
passes through the narrow passage of the Fallopian 
tube, which, by its undulatory motions, carries it on 
one or more ova. The seminal aura then penetrates 
into the membranes with which they are covered, 
mixes its atoms with the substances of the ova, and 
impresses on them the elements of life. The ovum, 
fecundated by the semen of the male, swells and tume- 
fies, assumes a yellowish color, and in a few days is 
detached. The Fallopian tube, whose fimbriated ex- 
tremity has remained applied to the ovary during the 
whole period of conception, receives the homocular 
germe, and deposites it on the uterus,t where it receives 
the elements for its development, and after remaining 
here during gestation, nature thrusts it into the 
world. 

* De Graaf and Magendie have shown by experiments that during the 
act of coition, the edges of the Fallopian tubes were erected, and applied 
to the ovaries. 

t See Velpeau's Tables on Embryology. 

5 



50 STERILITY — CAUSES — TREATMENT 

Whatever may be the system by which the physiol- 
ogist explains generation, he is forced to admit that 
this function requires, in the sexual relations, a con- 
currence of physical and moral conditions, without 
which it becomes necessarily impossible or unproduc- 
tive. Let us leave the field of hypothesis to follow 
and determine these different conditions in the two 
sexes. They relate — 1. To the organs of conjunc- 
tion. 2. To the organs of secretion or fecundation. 
3. To the organs of education or preservation. 4. 
Finally, to many other important considerations which 
oppose impregnation. 



IN THE MALE AND FEMALE. 51 



CHAPTER II. 

ETIOLOGY AND THERAPEUTICS OF STERILITY. 

As the causes of sterility constitute for the most 
part so many real diseases, we have thought proper to 
study in the same chapter these two objects which, as 
formerly remarked, ought always to follow each other 
as a shadow follows the body. In fact, it is only by 
adapting the medication of a disease to its cause that 
we can expect to cure it. To establish some order in 
the explanation of such matters, we shall follow the 
plan pursued in describing the genital organs of the 
two sexes ; to omit none of the circumstances on 
which it treats, we shall consider in detail the causes 
of sterility, and study them separately, and mention 
the mode of treatment demanded by each. 



SECTION I. 

STERILITY IN THE MALE. 
ARTICLE I. 

Diseases of the Genital System considered in Man as a Cause of 

Sterility, 

§1. DISEASES OF THE ORGANS OF CONJUNCTION. 

1. Absence of the Penis, — There are several in- 
stances of this deviation of formation which may be 



52 STERILITY CAUSES TREATMENT 

congenital or accidental. Schenk {Ohservat. Medic, 
lib. 10), and Cattier {Observ. Med., No. 19), have re- 
lated two very remarkable cases of the first character. 
M. Fodere also (in his Medicine legale, vol. i., p. 564) 
has stated the history of a young soldier who had well- 
formed testicles, but in the place of a penis presented 
a prominence similar to a nipple perforated at its ex- 
tremity, from which exuded by friction a whitish fluid 
having the appearance of semen. This deformity may 
also be caused by the removal of the penis by a surgi- 
cal operation, by the bite of animals, or by a burn. 

Although the absence of the penis is generally re- 
garded as a cause of impotence, yet there are instances 
of persons destitute of this part and who have had 
families. In fact, to produce impregnation it is only 
necessary for the penis to present externally a promi- 
nence which permits the introduction of the semen into 
the sexual parts of the female. In some cases also, 
nature may be assisted by art in this latter condition. 

Lieut. Col. L received at the battle of Wa- 

gram a ball which passed through the centre of the 
penis. The inflammation in a few days was so in- 
tense that the part became gangrenous. Amputation, 
which was the only mode of saving the wounded man's 
life, was performed by M. Richard, surgeon-general 
of the hospital of Vienna, where the w^ounded man 
had been carried, and I took care of him. 

M. L. who had been married a few days before his 
departure for the army, was extremely anxious on his 



IN THE MALE AND FEMALE. 53 

return to pay his young wife his tribute of conju- 
gal love. Having had occasion to see him at this pe- 
riod, he related to me his infirmity which seemed to 
take away from him all hope of being a father. In 
this state of things I recommended to him the follow- 
ing apparatus. I made for him, of gum elastic, a kind 
of cone five inches and a half long, open at its two ex- 
tremities, the narrowest end of which embraced the 
neck of the uterus, while the other was more sloping, 
and was fitted to the stump of the penis. A supposi- 
tory of gum elastic was placed in the rectum, while at 
the same time a slight friction of the perinoeum exci- 
ted the contraction of the vesicles and ejaculatory 
muscles and thus favored the emission of semen. By 
these means Mad. L. became the mother of two chil- 
dren. 

2. Excessive Size of the Penis. — Some authors, 
among others, M. Foder^, have regarded unnatural 
length of the penis as a cause of sterility. If this 
proposition can not be admitted generally, we must al- 
low that this circumstance in some cases may impair 
fecundation by the severe pains caused to the female 
in coition ; and also as a general remark, that the in- 
troduction of the penis too far in ihe act of venery is 
less favorable to fecundation, inasmuch, as then the 
semen penetrates less easily into the orifice of the 
uterus. But art can readily obviate this inconvenience 
by means of an apparatus placed on the vulva and 
perforated in its centre to receive the penis. 

5* 



54 STERILITY CAUSES TREATMENT 

3. Small Size of the Penis. — See article, Anaphro- 
disia, where I hope I have proved and demonstrated the 
mode of developing the tissues of the corpus caverno- 
sum by simple and physiological means. We can 
now erase from the treatises on medicine the remark 
that smallness of the genitals is an absolute cause of 
sterility. 

4. Deviations in the Direction of the Penis, — In 
some individuals the penis presents a direction which 
by destroying the natural relations of the sexual parts, 
(as it is seen in fig. 15), may prevent the penetration 
of the seminal fluid into the orifice of the uterus and 
thus render the coitus sterile, if this deformity be not 
corrected by proper means. This circumstance may 
also be the effect of a simple curve of the glans by 
the drawing down of the frenum during the erec- 
tion ; in this case the penis can be righted by dividing 
the frenum with scissors and preventing the adhesion 
of the divided parts by placing lint between the lips of 
the small wound. 

[Fig. 15.] 




Sometimes tumors are developed in the substance 
of the penis, which give it^a wrong direction, and become 



IN THE MALE AND FEMALE. 55 

the accidental causes of sterility. M. Patissier (in the 
Diet, des Sc. Medicales, vol. xl., p. 183) has men- 
tioned two cases of osseous concretions, large enough 
to produce this effect and impede the emission of se- 
men and of the urine. Both yielded to the use of 
mercurial frictions made for twer^ty days on the course 
of the tumor. 

The aneurismal dilatation of the corpora cavernosa 
and urethra may also give rise to a deformity of the 
penis. Both Albinus {Annat. Anatom.), and Rich- 
erand {Nos. Chir,), have cited a case of rupture of 
the fibrous membrane of the corpus cavernosum. I 
had occasion to observe the same accident in a colonel 
of cavalry after violent efforts of coition ; beside severe 
hemorrhage which occurred immediately, there ap- 
peared shortly after, at the ruptured part, a large tumor 
which increased at the moment of erection, although 
the extremity of the penis then preserved its softness 
and flaccidity. The surgeon-major of the regiment 
and myself recommended the patient to apply to the 
penis a cylinder of gum elastic arranged so as to press 
on the aneurismal tumor, yielding to the changes in the 
dimension of the organ. Mr. D., after being married 
two years, became a father, although he could not ex- 
ercise his marital privileges except by means of this 
instrument. Since that time I have seen in my prac- 
tice several cases similar to this, which have generally 
been followed by the same result if the same means 
were used. 



56 STERILITY CAUSES TREATMENT— 

5. Bifurcation^ or DouUeness of the Penis, — Many 
authors, as Schenk {Lih. 4, Ohs. 8), Weikard {AnnaL 
Med.) and Marc {Diet, des Sc. Med.^ vol. xxvii.), 
have mentioned instances of doubleness of the penis, 
but no one has yet considered this deformity with a 
view to sterility. If, however^ it does not always pre- 
vent the generative faculty, it may render the act of 
coition difficult, and even become an absolute and 
incurable cause of impotence, when the angle of 
bifurcation is such as to prevent congress of the sexes. 

6. Imperforation of the Prejpuce arid Glans. — When 
the prepuce and glans are imperforate, the fluids which 
escape from the canal of the urethra must necessarily 
find some other outlet. This deformity is easily rem- 
edied by a strait bistoury, a trocar and canula of silver, 
or gum elastic, with proper dressings. 

7. Hypospadias, — This is one of the most import- 
ant and severe diseases of the genital system. In 
modern times, most practitioners regard this deformity 
as the reproach of surgery. Many authors, as Haller 
{Diet, des Sc. Med., vol. xxiv), Eschenbach {Cours 
de Med. legale), Mahon, &c., have asserted that this 
was an absolute cause of sterility. Many cases related 
by Schenk {Obser. Med.), Petit-Radel {EncycL 
Method.), Koop {AnnaL de Med. pol.). Sec, tend to 
invalidate this statement ; but to decide how far hy- 
pospadias may injure or impede parturition, it is neces- 
sary to establish demarcations presented by this af- 
fection relatively to its seat, or to the circumstan- 



IN THE MALE AND FEMALE. 57 

ces which may favor the success of a surgical opera- 
tion. 

The term hypospadias is applied to a deformity in 
which the orifice of the canal of the urethra opens at 
the under part of the genital organ. It appears in 
different forms and situations, which render its cure 
more or less difficult, and sometimes impossible. The 
nearer the opening is to the glans, the more favorable 
the chances for success. * 

In most of these cases, the urethra terminates at 
the base of the frenum, near the fossa navicularis. 
In some cases, fecundation may doubtless occur. I 
have known some patients who have had children, 
notwithstanding this arrangement. Morgagni, Sabatier 
(who was himself affected in this way), Dupuytren, 
Boyer, Richerand, and Maltati, of Vienna, have known 
persons to be fathers of many children, although the 
urethra opened below the glans. Under similar cir- 
cumstances, fecundation could not occur, because the 
glans was curved too much downward during the erec- 
tion. The opening of the urethra was closed by this 
direction, and the seminal emission took place very 
imperfectly, or not at all. The semen would enter 
the canal during the erection of the penis ; it lost its 
prolific power, when the action of the genital organs 
did not nominally take place. 

The hypospadias may be double, forming two open- 
ings, one smaller near the extremity of the glans, the 
other toward the fossa navicularis. They rarely com- 



58 STERILITY — ^CAUSES TREATMENT 

municate, and the latter alone gives outlet to the 
natural fluids. Sometimes, it is situated in other 
parts of the canal of the urethra, before or behind the 
scrotum. Its orifice varies in size, but is always large 
enough to give passage to the urine and semen. The 
urine comes by jets, while the seminal fluid falls out 
in small clots, or in filamentous drops, and sometimes 
flows along the perineum. In these latter cases of 
hypospadias, fecundation is absolutely impossible. 

Let us now inquire into the best mode of operating 
for the relief of these cases. I have already said that 
most ancient and even modern authors have advised 
that these lesions should be left, stating that art could 
not remedy them, and that the examination of these 
lesions would prove the insufficiency, and even the 
physical impossibility of attempting any operation, on 
account of the composition of the tissues of the ure- 
thra, of the hemorrhage, and especially of the inflam- 
mation and of the constant discharge of the urine, 
which always impedes the cicatrization of the sides of 
these unnatural openings. Without discussing all 
these difficulties, and the remedies tried ineffectually, 
let us mention some successful cases, before stating 
our mode of operating. The Bulletin of Medical 
Sciences, for January, 1822, publishes a case of con- 
genital hypospadias, occupying the lower part of the 
penis, one finger's breadth from the base of the glans. 
The following operation w^as performed : the surgeon 
introduced a trocar and canula into the glans, and 



Mi 



IN THE MALE AND FEMALE. 59 

directed it from before backward, and a little obliquely 
from below upward, beyond the meatus urinarius, leav- 
ing the canula in the wound, and substituting for it 
subsequently a gum elastic bougie, until the canal was 
entirely restored. 

Ohservation, — This imperfect operation was of no 
real advantage ; the urine continued to flow through 
the unnatural opening, and much more would the 
semen follow the same course. 

We find a still more conclusive instance of hypos- 
padias than that we have mentioned, cured by M. 
Marestin, surgeon-in-chief of the hospital at Oleron, 
mentioned in the Journal Periodique de la Societe de 
Medicine. It was the case of a soldier 34 years old, 
who from his birth was affected with a perforation of 
the urethra at the anterior part of the perineum, through 
which the urine and semen passed. M. Marestin, to 
relieve this unnatural defect, introduced through this 
opening a grooved stylet, which he directed backward, 
and easily passed it into the bladder. He then car- 
ried the sound along the whole length of the anterior 
part of the urethra to the extremity of the glans, 
which was closed by a thick membrane. Notwith- 
standing the general opinion that the operation would 
fail, he tried it with the following result. The patient 
was placed in a proper position, and then, with his 
assistants, M. Marestin proceeded in the following 
manner. He introduced a probepointed stylet into the 
unnatural opening, and directed it on the membrane 



60 STERILITY— CAUSES TREATMENT 

which closed the glans, which he divided ; he then 
pared the edges of the perineal opening, placed a sil- 
ver sound in the urethra, which he introduced to the 
bladder ; he then united the pared edges of the open- 
ing by the interrupted suture. Six days afterward, the 
cicatrix appearing firm, M. Marestin withdrew the 
needles and the sound he had left in the bladder. 
Notwithstanding every care, the sound could not be 
withdrawn without severe pain, and the cicatrix of the 
urethra, which was not firmly closed, was lacerated. 
A new sound was introduced, and by bleeding, strict 
diet, the use of emollient fomentations or diluent 
drinks, the cicatrix was completely consolidated ; a 
stricture of the urethra remained at the spot of the 
cicatrix, which yielded entirely to the use of the 
bougies. 

After these two cases, I shall mention those occur- 
ring in my own practice. If I have omitted them in 
preceding editions of this work, it was because I wished 
to state authentic facts which have been frequently 
repeated, and the result of which has been the means 
of imparting happiness to many families, giving them a 
pledge of love, and rebuking the prejudices of some 
authors, as Boyer, Astley Cooper, and many other 
celebrated practitioners, who have supposed art to be 
ineffectual in such unnatural lesions. 

Case 1. — A German nobleman applied to me at the 
close of 1831. He was tall, thin, and spare, and was 
affected with a congenital oval broad hypospadias, with 



IN THE MALE AND FEMALE. 61 

thin uneven edges, situated between the two testicles ; 
the scrotum was loose and pendent, and often soiled 
with the urine ; when he neglected to raise the testi- 
cles to urinate, the urine came in jets, and the semi- 
nal fluid came out in drops, like expectoration ; the 
penis was about six inches long, its erection was always 
imperfect and painful, and curved, the urethra forming 
nearly a quarter of a circle ; the glans was well 
formed, exposed, a little large ; the frenum was defi- 
cient. To ascertain the nature of this deformity, I 
introduced a probepointed stylet into the hypospadias, 
and attempted, but in vain, to introduce it along the 
canal in its anterior part, which I soon found was en- 
tirely imperforate. The form of the urethra, how- 
ever, was well marked, establishing a kind of groove 
between the two corpora cavernosa to the fossa navi- 
cularis ; on the other side, the stylet penetrated readily 
into the bladder. This being ascertained, I pursued 
the following course, and performed an operation 
which I shall mention. A mild regimen, baths, and 
diluent drinks, were prescribed ; the penis was rubbed 
with an embrocation, the congestor* was then applied 
in different forms, and by a gradual and constant 
extension, repeated frequently with much care and 
even some difficulty, I obtained in eight months the 
retraction of the penis, that is, the three membranes, 

• This instrument will be described and figured hereafter. 

6 



62 STERILITY CAUSES TREATMENT 

the mucous, muscular, and spongy, and also the mus- 
cular fasciculi, which are found in the spongy tissue, 
were elongated about fourteen or sixteen lines. Things 
being thus arranged, I placed my patient in a proper 
position. 

First, I applied a congester on about a third of the 
genital organ, which after becoming congested was di- 
rected to the linea alba and held by an assistant. I 
introduced a sonde a dard, made for this purpose, into 
the opening of the hypospadias, and directed it from 
behind forward to divide the membrane which closed 
this canal. After some assistance I introduced the in- 
strument about six lines. After removing the con- 
gester which was no longer necessary to hold the pe- 
nis, I introduced a straight silver sound in place of the 
sonde a dard; I came imperceptibly, and without much 
effort to the end of the glans which was closed by a 
thick membrane, and which was also divided by a con- 
cealed sonde a dard. A straight gum elastic sound, a 
little larger than the sonde a dard, was introduced, ex- 
tending a few lines beyond the openings. We must 
remark that this part of the canal of the urethra, which 
extended from the opening of the hypospadias to the 
end of the glans, appeared perfectly well-shaped and 
formed of its usual tissues. Its parietes were not 
really adherent, but were compressed like a cord. 
The dressings were arranged properly ; suppuration 
and cicatrization occurred without accident. On the 
fortieth day, this portion of the urethra readily admit- 



Ai 



IN THE MALE AND FEMALE. 63 

ted a sound, which was passed into the bladder, and 
through which the urine escaped. 

The patient having recovered from the first opera- 
tion the second was attempted. The patient having 
been properly prepared, and the bladder emptied, was 
placed on a firm table. I carefully pared the edges of 
the hypospadias by removing all the slips with curved 
cataract scissors. (The operator should be careful 
that all the edges are entirely raw, as the success of 
the operation depends on this.) I now introduced a 
moderately-sized sound so as not to draw too firmly on 
the tissues on which I operated, and especially so as 
not to tear the recent wounds. Four fine needles 
were inserted ; the edges of the hypospadias were ap- 
proximated and kept in place by a waxed silk and 
compact thread : the hemorrhage was slight. There 
was no remarkable symptom till the third day. A 
small quantity of urine had passed through the sound. 
Inflammation supervened; the edges became engorged. 
I loosened the edge of the silk a little. It was cleansed 
with an emollient decoction, dressed with a pledget of 
lint slightly spread with cerate. The patient was bled 
from the arm ; strict diet was observed ; the symptoms 
were subdued ; the granulations rose on the wound ; 
a slight oozing appeared in the course of a needle, 
which was removed on the eighth day. The opening 
of the needle, and also the granulations were touched 
with a weak solution of nitrate of silver. On the 
eleventh day the sound was withdrawn, and the patient 



64 STERILITY — CAUSES — TREATMENT — 

remained three days without it. Some little trouble 
supervened in urinating; a new sound was introduced. 
On the twentieth day the patient was convalescent, the 
cicatrix appeared solid, and by touching we perceived 
a stricture in the urethra, which was removed by the 
use of bougies. 

Case 2. — M. Du , after consulting Prof. Rou 

and Dubois, came to me for my opinion. This 
young man had been affected from birth with a hypos- 
padias, situated three inches and some hnes from the 
summit of the glans. This orifice was shallow, broad, 
and three lines long, with hard and callous edges, 
showing the interior of the canal of the urethra. We 
readily passed a sound into the bladder. The rest of 
the canal of the urethra seemed well marked. A prob.e- 
pointed stylet passed rapidly through it to the summit 
of the glans which was imperforated. I advised the 
operation. This young man, however, would not give 
his consent until he had consulted his relatives and the 
venerable Dubois, my respected instructor. On the 
day appointed the patient was prepared, and the sonde 
a dard readily perforated the membrane which closed 
the opening of the glans. In a few days the wound 
was cicatrized, and the urine passed from the glans 
through a sound. The second operation was much 
more difficult than in the hypospadias of the preceding 
case. As the edges of this opening were callous, it 
was necessary to remove a great part of the substance 
to render the edges raw, so that less than one half of 



IN THE MALE AND FEMALE. 65 

the diameter of the canal of the urethra remained : it 
was necessary to take a very small sound. I tried to 
bring the edges of the wound together with very fine 
needles, but could only introduce two of them. I was 
obliged to make six points of interrupted suture with 
the needle and waxed thread : further the operation 
w^as performed without accident. The patient was or- 
dered to drink only cold lemonade in small quantities, 
in order to diminish the quantity of urine which pas- 
sed drop by drop from the sound. The third day he 
felt severe pain near the neck of the bladder ; extreme 
agitation ensued with quickness of pulse ; he was bled 
twice ; twenty leeches were applied successively three 
times to the margin of the anus and perinoeum, and 
emollient fomentations, &c., were used. The bladder 
was emptied several times daily by the pump. The 
fever subsided ; the pains became less, but did not dis- 
appear entirely ; the points of the suture inflamed, the 
internal engorgement and the fluctuation of the urine 
felt behind the part operated on, forced m^to with- 
draw the sound, which caused the patient to have vio- 
lent pains. Several leeches had been applied behind 
the part operated on, and also cataplasms and emol- 
lient baths, &c., were used. I was obliged to remove 
the two needles on the fifth day, and to cleanse the 
parts. On withdrawing the sound, a portion of the 
ill-united cicatrix was torn open, and urine escaped 
from it. I was obliged to cut out the points of su- 
ture, but the diluent treatment soon removed all the 

6* 



66 STERILITY CAUSES TREATMENT 

symptoms. The wounds of the hypospadias were 
promptly reheved, but its opening necessarily re- 
mained larger : we then regarded the hypospadias as 
incurable, as there was not enough of the urethral tis- 
sues to permit the wound to be united. When the 
patient had recovered, I introduced a gum elastic 
sound whose thin parietes slightly increased the capa- 
city of the urethra, and caused him to wear it. To 
this he soon became accustomed, even during the 
erection of the penis. Coition being now performed, 
I was assured that most of the seminal fluid passed 
through the sound, which projected but a few lines 
from the natural opening. This young man was twen- 
ty-six years old, of a vigorous constitution, was mar- 
ried, and had two children in three years. 

Case 3. — I was more fortunate in the following case. 

M. Sch , son of an English manufacturer, aged 

thirty years, of a moderate height, of a vigorous con- 
stitution, often impaired by hard labor, had never been 
intimate with females ; he urinated through a fissure sit- 
uated in front of the testicles, where we readily discov- 
ered a hypospadias oval in form, and seven lines long. 

A sound penetrated readily into the bladder, and I 
introduced a probe-pointed stylet into the groove pre- 
sented by the corpus cavernosum, which formed the 
other part of the canal of the urethra. With some 
effort, I succeeded in passing it into this passage, 
toward the inner third, but could not proceed farther 
forward. I then introduced into the canal emollient 



IN THE MALE AND FEMALE. 67 

oily injections, which brought away some sebaceous 
material ; dilatation was accomplished by sounds, and 
I finally came to the fossa navicularis, without being 
able to pass through the urethral part of the glans. 

The sonde a dard was required to pass through 
this part in the natural direction ; it must be remarked 
that the glans curved on the urethra, presented no 
appearance of opening ; the whole surface of the 
glans was covered ; there was no frenum, and the pre- 
puce was very small. Hemorrhage at first was pro- 
fuse ; it was arrested by compression, and the sonde 
a dard remained in the canal of the urethra ; it could 
not be withdrawn and replaced by a bougie, till suppu- 
ration was established. The inflammatory symptoms 
were treated antiphlogistically. On the twenty-fifth 
day, the canal appeared cicatrized, and the bougie 
passed freely into this part of the canal. The opera- 
tion for hypospadias was performed, as in the first 
case, with entire success ; the raw edges of the wound 
were kept in place by five needles, without the slight- 
est accident, except some erections, which were sub- 
dued by cold emollient lotions. On the seventh day, 
I withdrew one needle ; on the eighth day, two ; on 
the tenth, the other two were readily removed. The 
wound was touched freely with weak nitrate of mer- 
cury. The sound being withdrawn, the urine flowed 
freely from the canal, but, nevertheless, I introduced 
another. On the twentieth day, the patient was en- 
tirely recovered — the cicatrix was firm. About two 



68 STERILITY — CAUSES TREATMENT 

months after this operation, M. Sch. attempted the act 
of coition ; his first essays were ineffectual ; but after 
applying the congestor for three weeks, the genital 
organs acquired the necessary development to exercise 
the procreative function with facility. 

I shall conclude this article with two other cases. 

Case 4. — An individual, who had been married for 
fourteen years, having a wife twenty-nine years old, 
perfectly fitted for reproduction, was doomed to ste- 
rility, that curse of married life; and this, notwith- 
standing the advice of several physicians. The penis 
was without a frenum, and curved, and the orifice of 
the urethra was situated in the centre of the perineum. 
The erections were very free, coition was readily per- 
formed ; but the semen escaped through the unnatural 
opening, and could not be introduced into the vagina. 
That portion of the canal which was directed toward 
the bladder was very free, and the sound passed 
through it easily. The course of the other part, 
though well marked between the corpora cavernosa, 
was narrow, and studded with sebaceous matter. The 
glans being perforated, sounds and bougies of differ- 
ent sizes, with the sonde a dard, to make or rather to 
finish the opening of the glans, gave to the urethra its 
desired capacity. Six weeks after, the operation was 
performed by the interrupted suture; the utmost pre- 
cautions were taken to avoid inflammatory symptoms, 
and the contact of the urine between the sound and the 
hypospadias. The last needle was withdrawn on the 



IN THE MALE AND FEMALE. 69 

seventh day. Finally, the cicatrix appeared closed 
on the fifteenth day. Sometime afterward, copulation 
was readily accomplished, and the individual soon 
became a father. 

Case 5. — A young Frenchman, twenty-eight years 
old, a little exhausted by the fatigues of war, of mod- 
erate size, but very irritable, was sent to me by Prof. 
Roux. He was affected with a hypospadias, three 
fingers' breadth behind the fossa navicularis, the im- 
perforate glans was entirely exposed, and although 
without a frenum, was curved on the urethra. The 
opening was fissured in its extent, and even its lips 
were irregular, the course of the urine was free and 
formed a strong jet, while from the non-erectility of 
the virile organ, the semen escaped very imper- 
fectly, and by small drops, on account of the curve of 
the member. Roux approved of my proposed plan of 
treatment, aided by the advice of my esteemed breth- 
ren, Nauche and Laurens, who assisted me in this 
long and difficult treatment. The penis, when erected, 
measured about five inches, the urethra only four and 
two Hues. Many months were required to elongate 
the tissues of the urethra by the congester. We ob- 
tained an increase of eight lines, which was thought 
sufficient, and proceeded to the operation, after the 
following method : The urethra seemed to terminate 
toward the navicular fossa, the glans formed a uni- 
form mass, without the slightest trace of an orifice. 
It was decided to make through the glans, a passage 



70 STERILITY CAUSES TREATMENT 

in the place where it generally exists, trying to touch 
the tissues as slightly as possible, and then to form 
the termination of the urethra at the expense of the 
integuments. 

A sound in the form of a trocar was introduced into 
the opening of the hypospadias, and directed from 
below upward, following the natural direction. I ex- 
perienced much resistance, but finally came to the 
summit of the glans, which was divided only for about 
three lines. I immediately passed in a sound, which 
came to the bladder ; the hemorrhage was at first pro- 
fuse, but was soon arrested. After allowing the pa- 
tient, who had fainted, to rest, he requested us to per- 
form the other operation, contrary to our wishes, as he 
was in a hurry to leave Paris. 

The edges of the hypospadias, which were very 
thin, as I have stated, were removed, so that all the 
tissues of the urethra might be united by the same 
suture. It was very difficult to accomplish this union, 
on account of the free discharge of blood, which pre- 
vented us from inserting our needles ; the edges, how- 
ever, were brought together and kept in place by the 
twisted suture. Notwithstanding the utmost care, a 
little blood remained in the canal. On the night after 
the operation, the patient was attacked with violent 
fever, pain in the bladder, &c. Leeches were apphed 
twice to the perinoeum, emollient cataplasms, bleeding 
from the arm, diluent drinks, and strict diet, subdued 
the disease a little, but the pain in the bladder and 



IN THE MALE AND FEMALE. 71 

urethra re-appeared, and considerable swelling was 
seen around the opening operated on ; we again used 
leeches and emollient baths. The fourth day, we ob- 
served a discharge from the suture. On the fifth day, 
we were obliged to withdraw the needles ; there was a 
great discharge of fetid matter, with small clots of 
altered blood ; the wound was properly dressed, but 
gangrene soon attacked these parts, and they sloughed 
off; it was soon seen that a new operation was im- 
practicable, from the want of tissues. The sound had 
been withdrawn and replaced by a bougie, which did 
not enter the bladder ; cicatrization occurred rapidly. 
When the patient recovered, he wished to indulge in 
the copulative function. The member was less 
curved, the unnatural orifice was much larger, the 
semen jetted out and was thrown into the vagina. An 
irritation occurred at the neck of the bladder, which 
was treated by antiphlogistics, and only a painful run- 
ning from the urethra remained, the seat of which was 
at the posterior part of the hypospadias, and in a por- 
tion of the urethra where bougies had been used. 
Cauterizations were used frequently, but unskilfully by 
the patient, for several months. This young man 
married, and by the aid of a gum elastic tube, which 
was almost straight, and which extended nearly an inch 
beyond the unnatural opening, which was itself closed 
by a piece of oiled silk, when the penis was erected, 
he was enabled to exercise the functions of coition, 
and in due time became a father. 



72 STERILITY CAUSES TREATMENT — 

Remarks, — The success of this last case is due to 
the advice of my distinguished professional friend Dr. 
Guillon, who demonstrated to me the possibility of 
continuing that part of the urethra which was deficient 
in the patient, and of restoring it at the expense of the 
adjacent integuments as the nose is formed in rhino- 
plasty. The following is the case. A man, forty- 
five years old, of middle stature, was affected with 
congenital hypospadias, which existed in front of the 
scrotum, and which measured eighteen lines in extent. 
There was almost an entire loss of the substance of 
its edges. This opening was very deeply grooved. 
It was easy by the means indicated to form the canal 
of the urethra to the end of the glans which was im- 
perforate. After the cicatrization of these parts, I 
proceeded to the following operation. A sound of 
sufficient size being inserted along the entire length of 
the canal of the urethra, I made two incisions on the 
sides of the hypospadias, sufficiently deep and exten- 
sive to form that part of the urethra which was defi- 
cient. On the other hand, the orifices of the hypos- 
padias were divided and part of their substance re- 
moved. I then brought the tegumentary parts over 
the sound, and I made a twisted suture with five 
needles. The whole was kept in place by a proper 
dressing, and the inflammatory symptoms were treated 
without accident. The patient was very docile, and 
readily submitted to all that was required of him. On 
the sixth day I withdrew two needles, and the others 



IN THE MALE AND FEMALE. 73 

were kept in place till the following day. The dres- 
sings were applied very carefully, and solid cicatrices 
were formed by cauterization with the nitrate of silver, 
but the g^vA elastic sound, which was frequently moved 
in the canal, was not withdrawn till the sixteenth 
day. I was afraid to remove it sooner, lest it could 
not be replaced without destroying the weak cicatrices. 
The patient wore a bougie in the canal for forty-five 
days, and the urine and seminal fluid readily took their 
natural course through the urethra. 

8. 0/ ^Epispadias. — This deformity was so termed 
by Chaussier and Dumeril in opposition to hypospa- 
dias. It consists in the opening of the canal of the 
urethra on the back of the penis, between the two 
corpora cavernosa, and a greater or less distance 
from the pubis. Ruisch,* Salzmann,t Morgagni, 
Chopart, Chaussier, Dumeril, Richerand, and Bres- 
chet, have observed that this disease is much more 
rare than hypospadias. 

The case related by Salzmann is that of a young 
man in whom the urethra opened near the arch of the 
pubis, on the back and at the base of the penis, be- 
tween the corpora cavernosa, and extended to the 
top of the glans wrhich was, in comparison v^ith the 
length of the penis, nearly divided into two, and flat- 
tened on its surfaces. Chopart, in his treatise on dis- 
eases of the urinary passages, mentions the history of 

* Thesaur. Anat., No 3L Asser. 2. No. 22. f Art. Nat. Cur., vol. iv. 

7 



74 STERILITY CAUSES TREATMENT 

a child, in whom the urethra opened near the pubic 
arch. We shall mention two cases to demonstrate the 
means used to enable the two subjects of these cures 
to have children. 

Baron de L , residing at Vienna, was about 

twenty-eight years old, tall, of a delicate rather than 
of a strong constitution, and was affected at buth 
with an unnatural opening of the urethra at the base 
of the penis under the bones of the pubis ; this orifice 
was grooved from belo^v/ upward, and admitted a large 
sound which penetrated readily to the bladder. The 
lurine flowed out by jets, and had an upward direction; 
the semen also followed the same course. The penis 
was formed unevenly, and measured about five inches 
three lines. The glans was half covered by a thick 
prepuce, and was sufficiently well formed in its state 
of erectility. The genital organ formed an eighth of 
a circle, and we remarked in it a kind of groove which 
seemed to be the continuation of the urethra, and was 
directed toward the glans. This person was seen by 
several physicians as Sir Astley Cooper, Dubois, Scc*^^ 
and all considered him as unfit for procreation. On 
consultation it was determined, however, to try to in- 
troduce the sonde a dard into the groove, following the 
direction it presented on the back of the penis, and to 
attempt the union of these two orifices after the forma- 
tion of this part of the canal of the urethra. The pa- 
tient being placed properly, and Dubois present, I 
made an incision with the bistoury into the centre af the 



IN THE MALE AND FEMALE. 75 

prepuce behind the corona gland is, and with the sound 
I followed the groove of which I speak, found some 
resistance in the centre, which I overcame by depres- 
sing the genital organ, and came to the pubic extrem- 
ity. The sonde a dard was withdraw^n and replaced 
with difficulty by a very flexible straight sound of gum 
elastic. The hemorrhage was slight, and the patient 
who was very docile, experienced no bad effects from 
the operation. 

In four weeks this urethra was formed. It was then 
proposed to unite the two orifices. The apparatus be- 
ing arranged, as also a support, formed of several 
pieces easily removed, the two orifices were made raw 
by curved cataract scissors. The first two points of 
suture were made with a fine curved needle, threaded 
with a wax thread. I then introduced a wax sound, 
finished very carefully, and much more flexible in the 
part which passed through the curves of the congeni- 
tal canal to come into the bladder. (I should here 
observe that for several days the patient had been ac- 
customed to the impression of the sound, and also to 
mild injections into the bladder to obviate nervous and 
inflammatory symptoms.) This sound was introduced 
and kept in place by an assistant, the suture was con- 
tinued, the dressing made, the penis was directed a lit- 
tle upward, kept in place by a bandage, and by the 
hand of an assistant, whose duty it was to favor the 
discharge of the urine and to guard against bad symp- 
toms. The patient was confined to a strict diet, and 



76 STERILITY CAUSES TREATMENT 

having great courage and admirable patience, he sub- 
mitted to all the painful and fatiguing positions required 
of him. On the fourth day I loosened the points of 
suture a little : on the sixth day I divided some of 
them, and removed them successively : several times 
the granulations were cauterized. The cicatrix, which 
represented a small ring, closed firmly in a few days, 
the urine passed readily through the entire canal, and 
came out by jets, behind the prepuce. 

Baron L , with good regimen, and especially 

with the aid of the congester, obtained all the erectility 
necessary to fulfil the marital functions. He has since 
married, and now has five children. 

The second case is no less interesting than that I 
have mentioned, but unfortunately was not so success- 
ful. Dr. Willis, first physician to the Emperor of 
Russia, under whom I had the honor to serve, sent me 
a young Russian prince, twenty-three years old, of 
middle height and thin. At the root of the penis, 
near the pubic arch, he had a narrow epispadias, which 
entered at the corpus cavernosum almost at a right an- 
gle : the urine also was passed in jets. When the pe- 
nis was depressed it had a cylindrical form, and was 
very short ; the glans was large and short, surrounded 
by a prepuce forming a large lip, which impeded its 
introduction into the vagina. The erections were im- 
perfect and infrequent, and there was but little inclina 
tion to indulge in coition, which was rarely exercised. 
There was no trace of an urethra on the back of the 



IN THE MALE AND FEMALE. 77 

penis. This being ascertained, I removed the shape- 
less prepuce. After its cicatrization, I tried to form 
under the integuments a canal to close the unnatural 
orifice. In fact, I directed the sonde a dard from before 
backward, under the integuments, between the two cor- 
pora cavernosa. The instrument was pushed as far as 
possible opposite the opening of the epispadias. This 
artificial canal required a long time to form, notwith- 
standing our utmost care ; some parts also suppurated 
slightly, when the young man became impatient, and 
insisted on the third operation, in which an attache of 
the Russian embassy assisted. Before the operation 
I stated my doubts as to its success, because the arti- 
ficial canal was not completely formed, and I feared a 
new inflammation. I operated in the same manner as 
in the preceding case, but the operation was very 
painful. From the second day the patient was agita- 
ted and could not remain tranquil. Considerable 
swelling supervened along the canal and at the points 
of the suture. General and local bleeding, the long- 
continued use of emollients and diluent drinks were 
by turns used without allaying the irritation which the 
patient increased by his in docility. It became neces- 
sary to withdraw the sound and to cut the threads of 
the suture. The urine resumed its first direction : 
every symptom yielded rapidly, but the artificial canal 
was partially effaced. The patient would not consent 
to the formation of another one, but a gum elastic 
sound was introduced in the unnatural opening, and 



78 STERILITY CAUSES TREATMENT 

kept there by a small riband tied around the glans. 
The use of the congester produced strong erections, 
and finally he became accustomed to the reproductive 
functions. I have learned that the prince was married 
and has become a father by the use of the means I 
suggested. 

9. Phymosis. — The natural or accidental contraction 
of the prepuce, as seen in the figure, may be such as 

[Fig. 18.] 




to render erection'painful, copulation difficult, and the 
injection of the semen into the vagina impossible. 
This makes fecundation more or less difficult, unless 
this deformity be remedied by an operation which con- 
sists in dividing the superior part of the prepuce with 
the bistoury or scissors, and in dissecting the lips of 
the wound, when the prepuce is hard, callous, or when 
it is excessiv^ely elongated. 

10. Paraphymosis> — This accident generally occurs 
when the prepuce is too narrow, and is drawn rapidly 
backward to expose the glans, as is seen in the cut 
No. 16. This not only soon becomes painful, so as 



IN THE MALE AND FEMALE. 79 




to impede coition, but inflammatory symptoms are fre- 
quently developed to such an extent as to lead to the 
fear of gangrene. This kind of strangulation is rem- 
edied by general bleeding, by pricking the painful 
spots, the use of baths, emollient cataplasms, &c^ 
The return of the trouble is avoided by the operation 
mentioned in the preceding case. 

11. Total or partial Deficiency of the Prepuce. — 
Beside the malformations just mentioned, the whole or 
part of the prepuce may be deficient ; and this deform- 
ity may be congenital, but it is more frequently acci- 
dental. When the prepuce is partially deficient, the 
remnant forms a rounded sac, or kind of cylindrical 
appendage, varying in length, but which impedes cop- 
ulation, renders it painful, and requires an operation, 
which consists in removing the appendage. The same 
inconveniences do not exist when the prepuce is total- 
ly deficient; but it is asserted that when this is the 
case, and the glans is exposed to the contact of the 
clothing, it loses a portion of its sensibility. This 



80 STERILITY CAUSES TREATMENT 

Circumstance, and perhaps the desire of correcting the 
deformity, and also the wish not to be suspected of 
belonging to certain religious sects who use circumcis- 
ion, have induced persons who were affected with this 
deformity to have recourse to art ; and history states, 
that in the time of the Roman emperors, the Jews, in 
order to evade the vexatious imposts imposed on them,, 
endeavored to efface all traces of their origin, by sub- 
mitting to an operation for making an artificial pre- 
puce. Celsus has described two modes of performing 
this ; one of which is applicable to the congenital loss 
of the prepuce, and the other to that resulting from 
circumcision. We, however, shall describe only the 
first, as the causes for performing the second have sub- 
sided. In the first case, then, as the skin is very ex- 
tensible, he advises to draw it from behind forward, 
and to tie it with a thread in front of the glans, leav- 
ing, however, an opening sufficient for the urine ; then 
to divide it circularly on a level with the base of this 
part, avoiding the subcutaneous vessels and the ure- 
thra ; bring it toward the ligature, and dress the wound 
until it has healed in such a manner that its edges can- 
not approximate. The success of this operation, how- 
ever, is very doubtful, for even in those cases where 
the result has been the happiest, the factitious prepuce 
can not present the same formation as the natural pre- 
puce ; and it is almost impossible to prevent erections, 
which may destroy all hope of cure by breaking the 
cicatrix. In one case where Petit attempted to reme- 



IN THE MALE AND FEMALE. 81 

dy a congenital absence of the prepuce in this man- 
ner, the edges of the wound approximated, and the 
circular cicatrix resulting from it formed around the 
penis a narrow bridle, while the factitious prepuce was 
changed into a very inconvenient sac. 

12. Abnormal Length of the Fremim of the Penis. 
When the frenum of the Denis extends too much un- 
der the glans, and especially when it proceeds to the 
orifice of the urethra, the patient feels pain whenever 
an attempt is made to bring the prepuce backward, 
the erection is painful, and the penis, in some cases, 
even curves downward during its rigidity, coition is 
difficult, and attended with a painful drawing sensa- 
tion, and the semen is thrown by the emission in a 
wrong direction. When the frenum is not very firm, 
it is sometimes broken during a strong erection, or 
during coition ; but sometimes it resists, and then a 
surgical operation is required. For this purpose, some 
use scissors, others pass a narrow bistoury flatwise 
through the frenum, and then turn up the cutting edge 
and bring it out, so as to detach the frenum from the 
lower part of the glans. If hemorrhage supervene, it 
can be arrested by the cautery. After the operation, 
the prepuce must be kept back by proper dressings, 
till the small wound is cicatrized. 

13. Abnormal Shortness of the Frenum. — When the 
frenum is too short, the glans is drawn downward by 
an erection, which causes a mis-emission of semen, 
and renders coition painful. The frenum is often: 



82 STERILITY CAUSES TREATMENT 

snapped during sexual congress ; but it is sometimes 
firm, and requires to be divided with the scissors. 

It is not sufBcient that the penis presents an organi- 
sation favorable to generation : it must also be en- 
dowed with a degree of vitality proper for the exercise 
of the act assigned to it by nature in the accomplish- 
ment of this function. It is thus its excess or want 
of sensibility may in some cases render the act of 
copulation unproductive or even impossible. This 
causes two kinds of sterility, which it is important to 
know. 

14. Satyriasis. — This constitutes the first case, and 
generally speaking, is only transient. The fruit of 
violent love or excessive passion, it almost always 
ceases with the possession of the beloved object, and 
generally speaking, there are few men who are sterile 
from this cause, after the early acts of marriage. We 
may mention, however, several persons in whom the 
sensibility of the penis was always so intense, even in 
a state of marriage, that the power of the ejaculatory 
muscles could not overcome that of the erection, which 
then tends to obliterate the canal of the urethra. Such 
was the case of the young man mentioned by Scheve- 
tel {Gazette de Sante, No. 52), who after several years 
of ineffectual effort, finally succeeded, by a very tem- 
perate regimen, in consummating the act of marriage, 
which excessive power and ardor had hitherto rendered 
sterile. This was the case also with that Venetian 
nobleman, whose amativeness was so great that he 



IN THE MALE AND FEMALE. 83 

consulted several physicians in Europe, and finally 
found a salutary remedy in the use of leeches, baths, 
&c., prescribed by Dr. Cockburn. Priapism, or mor- 
bid erection of the penis can not be considered as a 
cause of sterility, as it assumes all the symptoms of 
an acute inflammation, passing through the different 
periods with more or less serious symptoms, without, 
however, leaving any accidents which might affect 
generation. Priapism may be caused by want of 
cleanliness, the direct contact and rubbing of flannels 
upon the genital system, frequent gonorrhoea, noctur- 
nal pollutions, irritation of the urethra by sounds or 
bougies ; chronic inflammations of the skin, especially 
those affecting the genital organs, flagellation, and a 
very elevated temperature ; the most common cause 
of it, however, is the taking of cantharides. The 
same remedies are applicable to the two cases which 
usually yield to bleeding, warm baths, emollient ene- 
mata, camphor, emulsions, &c. Priapism is some- 
times cured by compression. This was the case with 
a young French officer, for whom we advised all the 
above remedies, in a case where there was priapism, 
with free emissions nightly, which caused great general 
debility and nervous excitement. He applied to the 
penis, on retiring for the night, a bandage, with a 
buckle at one extremity, and drew it up as far as was 
necessary, taking several circular turns round the penis. 
He also compressed the penis with a small wooden 
forceps of his own invention, the blades of which 



84 STERILITY CAUSES TREATMENT 

could readily be separated, when the swelling of the 
penis rendered it necessary. 

15. Anaphrodisia, — As we must study particularly 
that anaphrodisia which arises from general causes in- 
herent to the individual constitution, we shall treat 
here only of local anaphrodisia, depending on the 
diminution or loss of the sensibility of the genital sys- 
tem, in consequence of some circumstantial events. 
Regarded in this latter point of view, anaphrodisia, 
which constitutes one of the most frequent causes of 
sterility, depends on many circumstances to which it 
is useful to attend. One of the most frequent and 
fatal is undoubtedly the abusive and premature exer- 
cise of the genital organs, especially by excessive 
masturbation. The penis is wasted by constant titil- 
lation, a serous semen is discharged, which has no 
prolific virtues, and the virile member soon becomes 
flaccid, resisting all attempts at erection. How many 
individuals, exhausted by these manoeuvres, have 
vainly sought aid from their impotence, by marriage ! 
Enervated in their intellectual faculties, incapable of 
the slightest mental effort, they drag out a painful 
existence, onerous to themselves and to their wives. 
But let us turn from so sad a picture, to pursue the 
examination of the other causes of impotence. Who 
would think that causes exactly the opposite of the 
preceding might, in some cases, cause the extinction 
of the genital faculties. It has been remarked that 
absolute abstinence from venereal pleasures may debil- 



IN THE MALE AND FEMALE. 85 

itate and finally destroy the action of the sexual or- 
gans. This, at least, was the remark of Galen, in 
regard to the wrestlers who abstained from sexual 
intercourse w^ith a view to favor their physical devel- 
opment. The case, too, of a saint who devoted him- 
self to the most austere chastity, has also been stated, 
in whom but slight traces of sexual organs were found 
after death. In our day, however, extinction of the 
genital powers, from this cause, is extremely rare. 

The influence of different moral situations of man 
on generation, also, demands the entire attention of 
the physician ; for so close is the connection between 
the mind and the genital system, that the exercise of 
one constantly weakens the faculties of the other. In 
fact, in life there are a thousand circumstances where 
the soul is devoted to one object, and attracts to itself 
the whole activity of the nervous system, and renders 
the senses in a measure mute to the impressions of 
pleasure and voluptuousness. Man, whose attention 
is retained for a long time on the same series of ideas, 
seems to forget even the objects of affection around 
him : he lives only in the objects of his thought ; he 
is not alive even to the sensation of love ; and I do 
not think it strange that so many men, who have be- 
come illustrious in the sciences and arts, have mani- 
fested so much indifference to the sex. If the wri- 
tings of Boileau glow with the fire of the imagination, 
they are remarkable for their coldness to the female 
sex. Is it probable that if Newton (who is said to 

8 



86 STERILITY CAUSES TREATMENT — ^ 

have died a virgin), had been a prey to the torments 
of love, his works would have shown so nnuch genius 
and talent? These examples justify the happy idea 
of Cabanis, who has compared the sensibility to a fluid 
circulating in canals, the definite quantity of which 
diminishes as much in one part as it exists in excess 
in another. We will here mention an instance in sup- 
port of this. 

M. M , a magistrate, had been devoted in 

early life to intense intellectual labors, which had 
estranged him from male and female society. The 
most beautiful females had no attractions for him. At 
the age of twenty-four he had hardly experienced the 
slightest sensual impression ; but at this age having at 
tended, for the first time, the opera of Armida, the 
acting and music excited in his bosom the feeling of 
voluptuousness. This night M. M. slept amid all the 
illusions which such a spectacle could produce upon 
his senses. He was transported during sleep to the 
palace of Armida, where he perceives only images 
which paint to him happiness and pleasure, and finally 
his senses, which have hitherto been stupefied, inform 
him that he is a man. Devoting himself anew to his 
habitual labors, M. M. soon becomes inaccessible to 
love, until his thoughts are distracted by the society 
of a lady whose hand he seeks and obtains. M. M. 
promised himself happiness in this union. But, vain 
hope ! Far from being excited, his senses are only 
more alarmed at the sight of an object whose charms 



IN THE MALE AND FEMALE. 87 

would inflame any other person. In short, M. M. 
leaves the nuptial couch with the shame and conscious- 
ness of his impotence. I was consulted under these 
circumstances, and advised the patient to omit entirely 
his studies and professional occupation, to indulge in 
hunting, horseback exercise, and manual employment, 
especially gardening, which he preferred to every other. 
Every day the inner part of the thighs was rubbed 
with the anti-anaphrodisiac liniment (see the pharma- 
cology), the dose of which was gradually increased, 
and morning and evening the genitals were bathed with 
an infusion of aromatic plants, to which some drops 
of tincture of benzoin were added, sometimes substitu- 
ting for this remedy the asterasic pommade, or douches 
of Barege on the same parts and in the lumbar region. 
By this treatment, employed perseveringly for two 
months and a half, M. M. recovered entirely his virile 
powers, and became the father of a family. 

Other moral causes may oppose the designs of 
nature in the reproductive act. Some passions cause 
impotence by the excitement attending them, either 
because in this case, the emission of semen does not 
occur, or because it precedes the phenomenon of coition. 
Other passions, by an opposite effect, strike the geni- 
tal system with a kind of apathy, and often render the 
conjugal act impossible. Hatred, jealousy, the dis- 
persion of an illusion, the sight of some deformity, the 
disgust of a foul breath, deceived hopes, may give rise 
to anaphrodisia. 



88 STERILITY CAUSES TREATMENT — 

The affections of the mind also may prevent coition ; 
but we must admit that they are less incompatible with 
love than a great many passions, and especially than 
long and profound meditations. There are even cer- 
tain affections which seem to excite in the soul the 
sweetest impressions of pleasure : such are all those 
which affect the heart, and those which can be softened 
by tears or friendship. *' Love," says Madame Cot- 
tin, " the greatest of human felicities, to be vivid and 
durable, requires that grief should lend it tears : the 
child of melancholy, rather than of joy, its 6res are 
never move vivid than when lighted in eyes filled with 
tears, and it can only be eternal when nourished by 
sadness." 

Different hygienic circumstances also may cause 
anaphrodisia ; such as the long-continued use of cool- 
ing food, and drinks, fruits, and other substances 
which may produce a kind of collapse in the genital 
system. The same is true with the abuse of spirituous 
drinks ; that of coffee, and most of the solaneae, may 
have the same results, but it is important not to con- 
found the action of these different substances, as has 
been done by many authors who have written on this 
subject ; for these latter act in the same manner, as 
do all these causes which enervate and exhaust by ex- 
citing any system of organs. 

It has been thought that riding may weaken and sus- 
pend the genital functions. Hippocrates attributed the 
sterility of most of the ancient Scythians to this cause. 



IN THE MALE AND FEMALE. 89 

Very recently I have been attending a courier of the 
government, who was affected with impotence after 
long and uninterrupted journeys. 

The human species reproduces in every country, 
but the feeling which brings the sexes together is far 
from being the same under different latitudes. With- 
out seeking the proofs of this truth in the people who 
inhabit the poles and tropics, who differ essentially un- 
der this respect, we shall only compare, for an instant, 
the warmth of our neighbors of Belgium with the vivid 
ardor of those in the south of France. 

The seasons which make climates changeable, also 
have a remarkable influence on the genital powers. If 
the spring-time and summer are, as it has been said, the 
seasons of love, autumn and winter seem to be the pe- 
riods of repose for the reproductive life in the hu- 
man species as among all animated beings. This 
assertion is not only the fruit of analogy ; it rests on 
the tables of births and of population in different 
countries. Hippocrates had already studied this in- 
fluence, and thought that the seminal fluid experienced 
much more alteration as the temperature of the cli- 
mates is more varied, and the seasons are more irreg- 
ular : -'Plures enim corruptiones contingunt in se- 
minis coarctione, quum tempora frequenter variant 
quam si eadem sunt et similia." I am ignorant on 
what points the observation of Hippocrates may be 
founded : but while we admit that some climates and 

seasons are more favorable for the union of the sexes, 

8# 



90 STERILITY CAUSES TREATMENT — ' 

it is doubtful whether they exercise sufficient influence 
on the semen to render the conjugal act sterile.* Fur- 
ther, I leave this question willingly to the student of 
jurisprudence, inasmuch as it presents but a feeble 
point of contact with the object of this work. 

It is difficult to establish general rules of treatment 
for anaphrodisia, which requires so many therapeutic 
modifications depending on its different causes. When 
it arises from frequent emissions of semen, we should 
try to remove all physical and moral stimuli which 
might keep up an excess of sensibihty in the genital 
organs, coinciding most commonly with the exhaustion 
of the individual. Continence, change of air, mod- 
erate exercise, succulent diet, abstinence from acrid 
and stimulating food, should be the first remedies em- 
ployed. Tissot has advised in these cases preparations 
of iron with quinine : but I think the physician can 
not be too careful in the use of these remedies, at least 
unless the state of exhaustion in the patient is attended 
with no phenomenon of partial excitement, and even 
in the latter case it is important to pay some regard to 
the state of the gastric and pulmonary systems, which 

* Dr. D. Davis, in his " Principles of Obstetric Medicine," seems to 
entertain a different opinion. He remarks : " A respectable lady who 
has resided for many years in New South Wales, informed the author a 
short time since, that she had known many instances of females v/ho had 
ceased to bear children in Europe, becoming the mothers of second 
batches of children subsequently to their emigration to Botany Bay ; 
adding, that the fact was so notorious, that before she left that country, 
it was become the subject of current observation at Sydney." 



IN THE MALE AND FEMALE. 91 

might contralndicale their use. One remedy, which 
has been freely prescribed, and which seems to us to 
be peculiarly proper to re-establish debilitated muscu- 
lar strength, is the exercise of swimming. When by 
the aid of these hygienic remedies the vitality has 
been regulated in the different organic systems, and 
distributed properly to each, and the anaphrodisia is 
brought to a state of simphcity where stimuli are ad- 
missible, great advantages can be obtained from 
douches applied to the loins along the vertebral col- 
umn, from frictions around the genital organs with 
stimulating liniments, and from diffusible stimuli taken 
internally, being careful to measure the action of these 
remedies by the degree of excitement proper to give 
to the genital organs. Need I say that anaphrodisia 
arising from an opposite cause, that is, from absolute 
abstinence, will cease by exercise of the genital organs. 
When anaphrodisia springs from trouble of mind, 
which has absorbed all the vitality devoted to the ex- 
ercise of the genital powers, we must begin by forget- 
ting all subjects of thought, and by directing the mind 
to other things. Tissot treated successfully a case of 
impotence arising from obstinate study, by cold baths, 
and the use of a powder composed of acidulated tar- 
trate of potash, oxyd^ of iron, and a small quantity of 
canella. I have mentioned a case of anaphrodisia from 
this cause, which yielded to the long-continued use of 
sulphurous douches, frictions of cantharides, and other 
stimuli of the genital system ; but we must admit that 



92 STERILITY CAUSES TREATMENT 

less benefit is to be expected from these remedies, than 
from rest of mind added to exercise of the body and 
senses, in a word from the hygienic and moral reme- 
dies proper to divert vitality from the sensitive centre 
to which the whole of it seems directed. So, too, 
when anaphrodisia is produced by an imaginary power 
or any passion, the only mode of reheving it is by 
modifying the moral impressions. It is a fact, as 
Montaigne says, that we can find the remedies for imagi- 
nary evils only in the imagination. Impotence caused 
by the long-continued use of alimentary substances 
termed refrigerants, is cured most generally by food 
which is both nutritive and stimulant, such as animal 
gellies, which contain abundance of osmazome, most 
kinds of fish, and especially their roes, as containing 
more of the phosphoric principle, the Crustacea, oys- 
ters, crabs, &c., different vegetable substances, as 
truffles, artichokes, &c. Beside the employment of 
the general remedies deduced from the laws of hy- 
giene, and varied according to the nature of the causes 
of anaphrodisia, there is one class of remedies which 
seem to excite the genital system more directly, and 
which, for this reason, are termed aphrodisiacs. This 
series of medicaments embraces a great number of sub- 
stances from the natural kingdom, which, if properly 
used, become a powerful aid after that of the different 
hygienic remedies ; like the latter, however, the aphro- 
disiac remedies can not be subjected in their employ- 
ment to any special rules, inasmuch as these depend 



IN THE MALE AND FEMALE. 



93 



on many causes inherent in the disease or the individ- 
ual, and ahhough we have devoted several pages to 
the examination of such substances, it is with a view 
simply to their use by proper hands. (See chapter on 
Remedies.) 

Finally, there is another class of remedies to which 
art, in some cases, may have recourse to increase the 
turgescence of the penis, and fit it for sexual purposes. 
I allude to certain mechanical instruments or appara- 

[Fig. 20.] 





The Congester. 



94 STERILITY CAUSES TREATMENT 

tus. For this purpose I have invented an instrument 
called a congester^ cylindrical in form, from five to 
eight inches long, and from ten to sixteen lines in 
diameter, the extremity of which is free, while the other 
is so arranged that an exhausting pump can be attached 
to it. The penis is introduced into this cylinder, being 
careful to draw the prepuce backward : the instrument 
is directed upward. The congester is held with one 
hand, while the other hand works the piston to create 
a vacuum, and the corpus cavernosum soon swells, the 
blood gradually penetrates into every part, and the whole 
genital system feels the erectile impression of the pe- 
nis which is continued from five to twenty minutes. 
With the treatment prescribed, and the regimen indi- 
cated, we can always increase considerably the devel- 
opment of the penis, excite erections in individuals 
destitute of them, and re-establish them when lost. 
Instances in my practice demonstrate all the advan- 
tages derived from it. 

It has been said that the penis, by its texture, was 
but slightly susceptible of development in length or 
size. This is incorrect. By means of the congester, 
the penis may become very large in both directions ; 
the muscles can also gain in force and energy, as will 
be seen by tke following cases. 

Case 1. — A young man of Rouen, of a wealthy 
family, was attended a long time by M. Flaubert, a 
celebrated surgeon of Rouen, together with M. God- 
froy. It was not till the age of marriage that the 



IN THE MALE AND FEMALE. 95 

health of this young man improved, ahhough the ut- 
most care was bestowed upon him. Until this period 
he exhibited no signs of virility : nature had entirely 
denied her favors to him. The penis resembled a 
large wart ; the prepuce was fitted tightly to the glans, 
about eight lines long, flaccid in every part ; the cen- 
tral canal was very narrow; the right testicle was 
closely embraced by the scrotum, the left testicle the 
size of a nut, formed a tumor near the ischiatic notch ; 
the voice was acute, resembling that of a young fe- 
male ; there was no hair on the pubic region ; the 
skin was white and hot ; he had a dry cough ; the 
pulse' was very irregular, the body thin ; the spinal 
column was curved ; the muscular system but slightly 
developed. I apphed a congester adapted to the 
smallness of the organ, and made but slight exhaus- 
tion on the pump, using it at first but once daily, then 
twice, and so on, successively, till it was employed 
four times daily, not suspending it until the organ 
could enter spontaneously into exercise. The young 
man bathed the parts two or three times daily with cold 
infusions of mint, with a few drops of compound tinc- 
ture of benzoin ; the inner parts of the lower extrem- 
ities were rubbed with one of the liniments mentioned 
in this book in the pharmacology ; then the back 
and kidneys ; asterasic baths, frictions with a flesh 
brush and hair cloth were used at the same time with 
a tonic regimen. After five months of treatment, I 
found the penis had gained ten lines in extent, and the 



96 STERILITY CAUSES TREATMENT 

diameter had Increased in the same proportion, natu- 
ral erections commenced, the urine ran more freely, 
the glans was more uncovered ; as the prepuce impe- 
ded the extension of the corpus cavernosum I determi- 
ned to subject my patient to the operation for circum- 
cision, which was performed, as recommended by 
Ricord, viz., by drawing an inked line on the skin of 
the prepuce, corresponding to the base of the glans ; 
the prepuce was drawn forward, and the inked part was 
held firmly by an assistant with a pair of forceps. Then 
the surgeon takes that part of the prepuce projecting 
beyond the forceps with his left hand, and with a bis- 
toury cuts the prepuce at the inked line with his right. 

[Fig. 21.] 




When this is dope, the lining skin of the prepuce, 
w^hich can not be drawn forward, remains entire, and 
covers the glans ; this lining is divided by a single cut 



IN THE MALE AND FEMALE. 97 

wdth the scissors ; next the flaps are removed round to 
the frenum, and then the two flaps are held together 
and cut off, with the frenum, at one cut. The mode 
of holding the prepuce, &c., is seen in the cut. 

This operation was long and painful, as it was ne- 
cessary to dissect the inner skin of the prepuce, from 
its attachment to the glans. I carefully avoided touch- 
ing its envelope, preferring to leave the granulations, 
at the expense of the penis. This young man bore 
the operation courageously — he desired so much to 
acquire his genital faculties. In twenty-five days, the 
cicatrization was complete — the granulations were de- 
stroyed with alum and the lapis infernalis. 

Two months after this operation, I again resumed 
the use of the congester with the treatment, which was 
modified according to the indications. The penis was 
readily developed ; the blood flowed freely into the 
corpus cavernosum ; the canal of the urethra presented 
its normal dimensions. 

About the third month, the penis had enlarged 
twenty-two lines, which, with the ten lines gained be- 
fore, made an extension of thirty-two lines. The 
right testicle and spermatic cord of that side were 
manifestly larger. By slight pressure on the left tes- 
ticle, and by repeated exhaustion over this gland, it 
was much depressed, and was entirely disengaged from 
the inguinal notch. Finally, natural semi-erections 
supervened, which afterward became more free, and 
then frequent inclination to masturbation. Notwith- 

9 



98 STERILITY CAUSES TREATMENT 

Standing my counsels, this wish was irresistible, and 
was always followed by a free emission. In twenty 
months, the penis had elongated thirty-seven lines, and 
its diameter was increased eight lines. This treat- 
ment gave great muscular development ; all the organs 
increased remarkably ; the dorsal column became 
righted ; the voice acquired a graver tone ; hairs 
appeared on the penis ; and there were some signs of 
a mustache, &c. We must remark that all the hy- 
gienic principles were strictly observed ; the patient 
rode every day on horseback, practised gymnastic 
exercises, in which he has now become very skilfuL 
A year since he was married, and be has already a 
family. 

Case 2. — A young man, of Lille, twenty-two years 
old, of dehcate constitution, thin and tall, devoted 
himself early in life to study; he left college, en- 
tered the Polytechnic school, and applied himself 
devotedly to mathem^atics. In his infancy, he had 
frequently been troubled with bleeding from the nose, 
which exhausted him, and forced him to suspend his 
studies. Rest of mind, fresh air, pediluvia, &c., pro- 
duced a good effect. The assimilative functions re- 
appeared in a short time, and terminated the exhaus- 
tion caused by nasal hemorrhages, which were renewed 
as soon as the brain resumed its activity. The study 
of mathematics brought it on again ; and further, he 
contracted a very intense bronchitis. He had leave 
of absence for several months. Prof. Marjolin, his 



IN THE MALE AND FEMALE. 99 

physician, by a rational plan of treatment, succeeded 
in re-establishing his health. Hitherto, this young man 
had paid no attention to the genital organs, which were 
wasted, and almost invisible. M. Marjolin gave him 
wise advice on this point also, which, however, was of 
no benefit. He applied to me. The bronchitis had 
disappeared ; the hemorrhage reappeared on the 
slightest mental and bodily fatigue ; there was fre- 
quently suffocation when going up stairs, or on quicken- 
ing his walk ; the pulse was full, and sometimes there 
were palpitations. The face was alternately red and 
pale, and every fifteen or twenty days, it was necessary 
to apply twelve, fifteen, or twenty leeches to the anus ; 
he was cauterized on his left arm. The penis was 
small, flaccid, three inches two lines long ; the testi- 
cles small, of the form of a filbert, the spermatic cord 
long and thin, and the urethra was so narrow, that it 
required a long time to urinate. 

M. J., when seventeen years old, had some semi- 
erections, but for several years had been impotent, and 
he had felt no desire. His lower limbs were rubbed 
with an anti-anaphrodisiac liniment, and he used also 
warm* baths, with alcoholic tincture of ginseng and 
ambergris. 

The application of the congestor, although made 
very carefully, caused severe pains. The cellules of 
the corpora cavernosa opened with difficulty. It was 
necessary to employ for a long time local and unctu- 
ous baths, slight frictions of warm water, rendered 



100 STERILITY CAUSES — TREATMENT — 

more active by aromatic liniments, over the whole 
genital system, and also emollient fumigations. 

The application of the congestor was almost always 
painful, as the blood penetrated with difficulty into the 
corpus cavernosum. With patience and perseverance 
I succeeded, after six months of treatment and erec- 
tive exercises, in developing the corpus cavernosum 
as far as the glans. I applied the erector ; in a few 
weeks I obtained the desirable dimensions. I returned 
to the usual congestor, which I changed as the genital 
organs increased in dimensions. The treatment was 
attended with proper regimen and exercises. The 
health was invigorated. In the third month, hemor- 
rhoidal tumors appeared, from which much blood was 
discharged. After this time, there was no bleeding 
from the nose ; and from this time, there was more 
regularity in the functions, and erections commenced, 
which increased imperceptibly. At the tenth month, 
the penis had gained an inch and a half in length, and 
its diameter had nearly doubled. The urethra was 
much enlarged, the urine flowed freely, and the testi- 
cles, too, had become very large. At this time, the 
erections were nearly complete, and several seminal 
emissions occurred at night, after marked erections. 

After passing through the severe winter of 1829 
without any change in health, except from the effects 
of cold on the bronchiae, his treatment was resumed. 
Full erections were developed, by applying the con- 
gestor. But his natural timidity, his distrust of his 



IN THE MALE AND FEMALE. 101 

virile powers, and his mortification at using this instru- 
ment to develop the penis, retarded his convalescence. 
He finally renounced the instrument. When he was 
fearful of not fulfilHng the calls of nature, two or three 
spoonfuls of the anti-anaphrodisiac syrup, some baths, 
followed with frictions of the anti-anaphrodisiac lini- 
ment, increased the copulative power. Now M. J. is 
an engineer, in good health, uses no stimulant, and 
fulfils very well his marital functions. 

Case 3. — Count Ant. de R., a Russian, twenty- 
three years old, of a strong constitution, and very 
muscular, applied to me for advice in regard to his 
genital system. He stated that he had never had an 
erection ; that he was on the point of being married, 
but was fearful that he could not fulfil the duties of 
marriage. On examining the genital system, I found 
the testicles well formed, though small, near the root 
of the penis, and very much compressed by the scro- 
tum. The penis, when flaccid, measured only an inch, 
and had the appearance of a large tubercle. 

Treatment. — Diminution of food, gradual relin- 
quishment of wine, liquor, and coffee ; moderation in 
bodily exercise ; vapor baths as far as the kidneys 
serai-weekly ; diuretic drinks, sweetened with the 
anti-anaphrodisiac syrup ; the application of the con- 
gestor, which in two months caused complete erec- 
tions ; asterasic frictions to the kidneys ; and sleeping 
on straw. After using the congestor for sixteen 
months, the penis gained sixteen lines. Finally, after 

9* 



102 STERILITY — CAUSES — TREATMENT — 

two years of treatment, the penis measured, when 
flaccid, two and three quarter inches, and when erected, 
four inches ten lines. The erections were full and 
free ; the exercise of coition occurred, and with per- 
fect success ; the seminal emission was abundant. 
The count has since been married, and has had three 
children. 

Case 4. — The son of Lord B. sent for me to come 
to London, in 1826, to examine his genital system. 
He was thirty-three years old, tall, and remarkably 
fat ; and fond of eating and drinking. His genital 
organs presented the following state : The right testi- 
cle was very large ; the left was small, situated near 
the penis, and was not visible externally, but felt like 
an excrescence. The treatment was nearly the same 
as in the preceding case. In twenty-seven months, 
the penis was developed to three inches and four 
lines. At this time, erections were not complete, ex- 
cept by the use of the congestor ; the patient then 
indulged easily in coition. He was enabled to dis- 
pense with it when not fatigued by excesses at table. 

It is useless to mention a greater number of cases 
on the same subject ; those already narrated, will suf- 
fice to draw the attention of practitioners to this point, 
and induce them to pursue the same plan of treatment 
in similar cases. 

I have proceeded in other cases, where the genital 
functions have been lost (and which have been re- 
garded as incurable, from the idea that no treatment 



IN THE MALE AND FEMALE, 103 

and no hygienic or mechanical remedy could produce 
any vital or organic modification in the tissues of an 
organ, whose physiological functions were entirely 
extinct), by a combination, a succession of remedies, 
and unexpected success has crowned my efforts. Thus 
I have used, alternately, dry cups and cupping, moxas, 
cauteries, rubefacients, the vapor of liquids, flagella- 
tion on the lumbar, glutoeal, and perineal surfaces, but 
particularly shampooing and malaxating, which are 
very powerful. I have thought proper to mention the 
advantages of this, here, and have therefore devoted a 
few lines to this subject. Since the publication of the 
last edition of this work, I have been sent for to Eng- 
land, Germany, and latterly to Vienna, and Tuscany, 
to give advice to persons affected with anaphrodisia, 
and difficult and obstinate cases have obliged me to 
use a part of the means indicated, and I have derived 
the utmost benefit from shampooing. 

Of Shampooing and Malaxation. 

Shampooing and malaxatlon are performed on all 
the tissues of the organization, to excite and give ac- 
tivity and tone to the parts subjected to its action. 
Shampooing consists In pressing with the fingers the 
cutaneous surfaces, the muscles, and nerves, following 
the fibres as nearly as possible. 

From the Levant, Persia, and India, our first ideas 
of shampooing have been derived. In these coun- 
tries, there are persons who have served a regular ap- 



104 STERILITY CAUSES TREATMENT 

prenticeship, to know how to excite, invigorate, and 
restore the sensibihty and contractiHty of the organs, 
in order to re-establish their functions. These men 
have long thin fingers, and the last phalanges are very 
slight, and push through the tissues with admirable ad- 
dress. They distinguish readily the feeble or diseased 
fasciculi. It does not enter into our plan to present 
the complete history of this treatment, nor to make 
known all the advantageous results to be derived from 
it, which I had occasion to notice in Turkey. But 
we shall state here the numerous benefits which arise 
from shampooing and malaxation of the genital sys- 
tem, in some cases of anaphrodisia. The following is 
the course to be pursued : The surfaces being shaved, 
they are rubbed with a brush, or coarse stuff; we be- 
gin by shampooing lightly the integuments which cove? 
the muscles of the genital system ; this operation is 
made more active until the excitability of the individ- 
ual is sufficiently great. The patient then rests for a 
few minutes ; the shampooed parts are lubricated, and 
the muscles are then attacked ; at first, they are sham- 
pooed lightly, according to the direction of their fi- 
bres ; they are then malaxated until the patient feels 
severe pain. Frictions, with liniment or pommade, 
described in our pharmacology, are then used. When 
the fingers are not sufficient to penetrate the interstices 
of the muscles, I arm them with a prolongation of 
very firm leather, flattened in the form of a scraper, 
kept in place by a glove fixed around the wrist. 



IN THE MALE AND FEMALE. 105 

Each shampooing should be more or less prolonged, 
according to the degree of sensibility or excitability 
of the individual. It may be repeated once or twice 
a day, daily, or every two days. It is not till the 
parts which contribute simultaneously to the erection 
of the penis have been subjected to the action of sham- 
pooing, that we act on the envelopes of the testicles, 
the cord, and sometimes the testicles. Three instan-^ 
ces, taken from a great many practical facts, will suf- 
fice, I hope, to show the results of shampooing and 
malaxation, employed simultaneously with substances 
which act specially on the genital system, and with the 
congester. 

Case 1. — The Landgrave of , aged more 

than fifty years, thin and tall, had been affected with 
anaphrodisia for more than eighteen years, which 
supervened in consequence of excesses at table, in 
hunting, and in venereal pleasures. The virile pow- 
ers were nearly extinct, and had disappeared entirely. 
The prince married a young woman with whom he 
was desperately enamored, but could not ratify his 
marriage vows. He consulted in turn the most cele- 
brated practitioners in Europe, followed several plans 
of treatment, used electricity and galvanism, but with- 
out any aphrodisiac result. The celebrated Hahne- 
mann was sent for: he prescribed his wonderful drops, 
termed by his followers the ambrosia of the gods, but 
without producing the slightest action on the sexual 
organs. This gentleman was recommended to me by 



106 STERILITY CAUSES TREATMENT 

Prof. Hevercking, physlcian-in-chief to the grand duke 
of Hesse Darmstadt. On his arrival at Paris the prince 
was affected with intermittent fever contracted in Hol- 
land. In three months and a half his health was re- 
stored by proper hygienic treatment. About the end 
of May, 1833, we proceeded to the anti-anaphrodisiac 
treatment. An examination of the genital system dis- 
closed the following characters : the penis was long 
and flabby; the tissue of the corpus cavernosum was 
compact and firm to the touch ; the testicles were thin 
and small, enclosed in a loose scrotum, not tender on 
being touched ; a varicocele on the left side, and the 
genital muscles were but shghtly developed ; the blad- 
der was inert ; the urine ran slowly, and sometimes it 
was necessary to pass a sound : the feces were dry, 
always passed with difficulty, and costiveness frequently 
continued for several days.* 

Treatment. — The patient was first subjected to dry 
frictions, especially on the dorsal surfaces to the lower 
part of the thighs ; then all the parts were rubbed with 
flannel moistened with anti-anaphrodisiac liniment. 
The body was afterward covered with coarse red flan- 
nel.t He walked and rode out, which produced gen- 

* It is remarkable that most individuals affected with anaphrodisia 
are costive ; the rectum is inert ; the sphincter is so contracted as to 
cause constipation, sometimes for eight, twelve, and even fifteen days. 
The effect of shampooing removes this, which is sometimes attended 
with bad results. 

t I am ignorant why red produces a more marked action on the skin, 
than any other. The Irish, Dutch, and Danes, assure me that red will 
prevent and cure rheiunatism. 



IN THE MALE AND FEMALE. 107 

lie perspiration. I began the shampooing on the spi- 
nal and the dorsal muscles, following as far as possible 
the direction of the muscular faciculi ; the buttocks 
were then subjected to the same action, and also the 
muscles of the thighs for twenty-five days. All these 
parts were shampooed and malaxated once or twice 
daily. Every four days the prince took an asterasic 
bath at 24^. After five days of rest, the shampooing 
of the lumbar and the gluteal muscles were continued. 
The six muscles of the genital system were sham- 
pooed very carefully ; the shampooer introduced one 
finger into the rectum, and acted on the sphincter and 
levator ani muscles, which it is known embrace the 
seminal vesicles ; the other muscles were also sham- 
pooed, as likewise the prostate gland, the testicles, 
scrotum, and lastly the corpus cavernosum and the 
glans. All these parts having been malaxated nearly 
twenty days, I appHed the congester on the penis, 
which in time restored the turgescence of this organ, 
and caused it imperceptibly to assume its normal de- 
velopment. Ten months were required to fill all the 
cells of the corpus cavernosum, some of which ad- 
hered so closely, that there was danger of rupture by 
forcing the tissues with the instrument. 

The prince lay on a straw bed : he also took the 
anti-anaphrodisiac syrup, and soon began to feel in the 
night an unusual degree of heat in the sexual parts, 
which became congested with a slight degree of effort, 
and involuntarily toward morning the blood penetrated 



108 STERILITY CAUSES TREATMENT 

readily into the genital organ, and incited to sexual in- 
tercourse. Free discharge of semen indicated great 
activity in the testicles, which were manifestly devel- 
oped ; the health was perfect. When the erection 
was imperfect, the congester was used, which readily 
produced the necessary development of the penis. 

Case 2. — A rich landholder of Paris, aged sixty-six 
years, of a lymphatic constitution which had been well 
taken care of, and free from infirmities, had been a 
widower for seventeen years, when he was smitten with 
the charms of a young lady, and attempted to marry 
her. For a long time M. D. had refrained from the 
use of the genital organs, hoping that rest of the geni- 
tals would preserve his virile powers. About two 
months before his intended marriage he ascertained 
that he was impotent. -Prof. Marjolin, whose advice 
he solicited, prescribed for him a regimen and course 
of treatment which he did not follow long enough to 
derive any benefit from it. Prof. Roux was also con- 
sulted, and he prescribed thermal douches to the peri- 
neum, but the impatience of M. D. caused him to re- 
ject all treatment. He married, hoping his young 
wife would restore him. Vain hope! The lethargic 
torpor was always the same. Grieved at his position 
he again applied to Marjolin, who referred him to me. 
The sexual parts were well formed but soft and flabby, 
and perfectly inert. The malaxating and shampooing 
were used as in the preceding case, and also a proper 
course of diet and regimen. M. D., however, was 



IN THE MALE AND FEMALE. 109 

very impatient, and imagined that everything ought to 
yield to his wealth. Instead of hastening his recovery 
he impeded it. After ten months of very difficult 
treatment, the congester produced turgescence of the 
genital organs. The muscles in the perineal region 
were still very feeble, and the reproductive act could 
not be performed except by the aid of the rectal cyl- 
inder, which, by acting kindly on the muscular appa- 
ratus of the genitals, and by exciting and pressing di- 
rectly and indirectly on the seminal vesicles, gave tone 
to all the parts while the instrument rendered the erec- 
tion of the penis complete : M. D. now fulfilled the 
genital act, and fifteen months afterward his wife be- 
came a mother. 

Case 3. — Baron Suisse, a young man, thirty-three 
years old, tall, muscular, and in excellent health, was 
subject to strong venereal appetites. But at the age 
of sixteen years he was obliged, by religious motives, 
to restrain his amorous desires : his erectile powers 
gradually diminished, and finally were entirely lost. 
When twenty-four years old, he married a beautiful 
lady to whom he was much attached, but was aston- 
ished to find himself impotent. He consulted several 
physicians, and tried numerous remedies, but unsuc- 
cessfully. He was so desperate at his cruel situation, 
that he resolved several times to commit suicide. He 
came to consult me, and upon my positively assuring 
him that I would restore him, he placed himself under 
my guidance. 

10 



110 STERILITY CAUSES TREATMENT 

This was his situation : The genital organs were 
well formed, a little wasted from waat of exercise, the 
testicles were large and hard, and often became pain- 
ful from immoderate exercise on horseback, which con- 
tributed to keep up the atony of the perineal muscles. 
His health otherwise was good. 

Treatment. — Cessation of horseback exercise, dimi- 
nution of a too nutritious diet ; sleeping on a hair mat- 
tress ; general and local frictions, and with substances 
to excite special stability in the genital system ; the use 
of the congester, to bring blood to the organ. Slight 
erections imperceptibly came on, but not with force 
enough to permit coition, because the erector and 
ejaculatory muscles participated imperfectly, and but 
little in the turgescence of the genital organ. I now 
used shampooing, which soon manifested its good ef- 
fects, and then the genital system attained its normal 
dimensions, and free seminal discharges indicated great 
activity in the organs. Baron de Suisse is now the 
father of five children. 

Influence of the Cei'ehellum on the Generative Functions. 

In some cases of obstinate anaphrodisia, I have ap- 
plied remedies to the neck, and particularly to the 
occipital protuberance, from which I have derived 
great benefit, either by malaxating the integuments and 
muscles covering these parts, or by the use of anti- 
anaphrodisiac pommades, which cause irritation and 



IN THE MALE AND FEMALE. Ill 

inflammation, sometimes producing free suppuration ; 
sometimes, too, some flying blisters are sufficient to 
excite or quicken the virile powers. In other cases, I 
have used cups, moxas, and cauteries, which I have 
found useful. 

In priapism, satyriasis, hysteria — the results have 
almost been constant by the immediate appHcation of 
leeches to the occipital protuberance, the bites of 
which are covered with a thick emollient cataplasm ; 
in some cases, cold acidulated lotions, and even of 
snow or ice, have subdued neuroses of the genital 
system. 

We find in the Bulletin des Sciences de Medicine of 
Bologna, in July 1838, two cases under the term — 
" Cast comprovanti V influenza del cervelletto sulle fun- 
sioni delle jjarti generative,^^ 

Case 1. — This was the case of a female, aged about 
thirty-five years, and who was extremely amorous. 
She was struck violently on the head by a large limb 
of a mulberry tree, and fell to the earth senseless. 
She remained some time without aid, but gradually 
became sensible, and went into the house. Some 
days after this accident, she felt a disagreeable and 
even painful sensation in the vulvo-vaginal passage, 
whence there was a slight discharge of whitish matter. 
She remarked that when the pain in the vagina ceased, 
a severe pain came on in the neck, precisely in the 
spot struck by the limb of the tree. She was extreme- 
ly reluctant to indulge in sexual intercourse. Dr. 



1 12 STERILITY CAUSES TREATMENT 

Cittarelli bled her freely from the arm, recommended 
emollient semi-baths, diet, and diluent drinks. He 
prescribed two applications of leeches to the neck ; 
finally, on the fifth day, he ordered frictions on the 
occipital protuberance, with a liniment containing tar- 
tar emetic, which produced severe inflammation, and 
terminated by profuse suppuration. 

The vaginal discharge and pain disappeared entirely, 
and finally the reproductive functions resumed their 
former sensations. This female now enjoys perfect 
health. 

The second case was that of a man forty years old, 
who had severe inflammation in the testes, the cause 
of which he attributed to sexual desire ; he had al- 
ready experienced the same disease. The scrotum 
was swelled, hot, and painful. The physician who 
reported these two cases, detected an orchitis, which 
resulted from a great accumulation of semen (sper- 
matocele). He prescribed copious bleeding, warm 
baths at first, making them cold afterward, and tarta- 
rized lemonade for drink. The patient deriving no 
advantage from this treatment, twelve leeches were 
applied to the nucha, which were very beneficial to 
him. The diseased parts were bathed in snow water, 
uninterruptedly, for fifteen days ; and at the same time 
the nucha was rubbed with the liniment of Autenreith. 
These means were soon followed by the complete 
resolution of the inflammatory tumor of the testicles. 



IN THE MALE AND FEMALE, 113 



§11. DISEASES OF THE ORGANS OF SECRETION. 

1. Absence of the Testes. — The absence of the tes- 
tes from the bursae can not be considered a cause of 
sterility, for they are sometimes retained in the abdo- 
men for some years, and sometimes, even through 
life ; and this, although the individuals presenting this 
arrangement are equally prone to fecundation ; and it 
has even been remarked that this formation renders 
the venereal desires and the secretion of semen more 
active. 

The loss of a testicle does not necessarily imply 
the loss of the generative power, inasmuch as this cir- 
cumstance, of which we have but a few well-marked 
examples, seems to be attended with a hypertrophy of 
the remaining testes. According to Blumenbach, the 
Hottentots are said frequently to deprive their sons of 
a testicle on arriving at eight years of age, from the 
belief that this renders them swift runners. 

Those whom nature has deprived of both testes are 
c^tg^^JLerjle. Cases, however, have been cited, 
where those who have been castrated, have begotten 
children soon after the loss of the testes. Cabrol has 
stated the case of a soldier condemned for rape, in 
whom, after death, could be found no trace of a testi- 
cle, neither in the scrotum, nor in the abdomen. But 
these facts are far from being authentic, and it is ex- 
tremely rare that nature, so attentive to the phenomena 
10* 



114 STERILITY CAUSES— TREATMENT 

of reproduction, forgets the formation of organs which 
are specially designed for it, 

2. Wasting of the Testes. — Long-continued com- 
pression, absolute continence, and the advances of age, 
may waste the testes so as to destroy their functions. 
Instances of this accident, which, however, are rare, 
are found in Hippocrates {De aere, aquis, et locis) 
and Galen {Quest. 46). Individuals exposed to exha- 
lations of lead have also presented this peculiarity. 
{Traite de la Colique metal,, par F. W. Merat.) 

When the wasting of the testes does not result from 
any organic defect, we may hope for a cure by the use 
of stimulating hniments, as those of ammonia and can- 
tharides, by aromatic embrocations, by the removal of 
the causes which have determined it, and especially by 
the exercise of the wasted part, when it arises from 
long-continued continence. 

3. Adhesion of the Testes at the Suprapubic Ring. 
It may happen that the testes, on leaving the abdomen, 
are retained in the inguinal ring, and there contract 
more or less intimate adhesions, which cause them to 
waste and disappear. This circumstance may also 
cause their strangulation, and M. Richerand has hke- 
wise reported a remarkable instance of it. Prof. Du- 
puytren has seen the same accident, some years since, 
in an adult subject. The operation performed by this 
skilful surgeon was so successful, that the patient re- 
covered his health and his virile powers. I do not, 
however, think it right to attempt the operation in case 



IN THE MALE AND FEMALE. 



115 



of Simple adhesion of the testicle, even if the impo- 
tence attending it should resist every remedy. 

4. Hydrocele. — This disease, which Boerhaave rec- 
ognises as a cause of sterility, and which is seen in 
the cut, does not seem to impair generation, except by 

[Fig. 22.] 





The scrotum largely dis- 
tended. 



The scrotum distended to its 
utmost extent, and the position 
of the fluid shown. 



changing the natural dimensions of the penis, for no 
observation has yet shown that the secretion of the se- 
men is altered. 

5. Sarcocele and Hijdro-Sarcoccle. — This is not true 
of sarcocele and its complication with the preceding 
disease : for beside that these two affections render 
coition more or less difficult, they may give rise to 
sterility by the derangement they cause in the secre- 
tory action of the testicles : this circumstance, how- 
ever, can not necessarily cause sterility unless the two 



116 STERILITY CAUSES TREATMENT 

testes should be affected at the same time ; for the coi- 
tion may be productive of the secretion of semen, and 
take place on one side. Instances have been men- 
tioned also of individuals v^^ho retained their sexual 
prerogatives although affected with a double sarcocele. 
M. Marc thought that in this case the disease affected 
only the vaginal tunic : but some facts related by 
Roux tend to prove that it is situated only in the cel- 
lular tissue of the scrotum, although it there presents 
all the external characters of sarcocele. 

Reason alone should dictate the means to obviate 
the inconveniences resulting from scrotal tumors so 
large as to impede the generative act. Art may arrest 
the progress of the beginning of a schirrous indura- 
tion by sanguineous emission, baths, emollient cata- 
plasms, and other general means ; but as the existence 
of real sarcocele or cancer of the testicle must neces- 
sarily render sterile the individual affected with it, 
there is no other remedy for it but the knife. 

6. S])ermacocele. — This is less a cause of sterility 
by itself than by the circumstances which produce it. 
Thus, in fact, engorgements of the epididymis, pros- 
tate gland, vesicles, or canals, which carry the semi- 
nal fluid, generally cause this affection. 

If it were possible to conceive of continence so pro- 
longed as to cause this symptom, the first remedy 
would doubtless be to excite the emission of semen ; 
but as the disease is usually symptomatic, we must try 
to remove the causes by the different remedies for 



ij 



IN THE MALE AND FEMALE. 117 

each. (See diseases of the vasa deferentia, urethra, 
&c.) 

7. Ossification of the Testes. — The osseous transfor- 
mation of the testes is not very rare in persons ad- 
vanced in life, and have been detected several times in 
adults after schirrous induration of these organs, and 
even too in young men who had scarcely attained the 
period of puberty. Prof. Dubois castrated a young 
man eighteen years old, whose testicles were entirely 
ossified in the centre. This accident, which necessa- 
rily causes sterility, is incurable. 

8. Obstruction of the Vasa Deferentia. — -I am not 

[Fig. 23,] 




a. a. Portions of the vasa deferentia, whose sides are thiol?, and cavity 
very narrow. 6, b. Portions of the same canals, with less thick sides, 
and larger cavity, r, c. Extremity of each vas deferens, grows narrow 
again where it unites with the vesiculee seminales and the ejaculatory ca- 
nal, dy d. d, d. Vesiculae seminales inflated, e, e. Their arteries. fjf,f. 
Portion of the peritoneum covering the posterior part of the vesicidse 
seminales. g, g. Ejaculator canals. — (Graaf.) 



118 STERILITY ^CAUSES TREATMENT 

aware that pathological anatomy has yet noticed this 
morbid state. If, however, we bear in mind the length, 
tortuousness, and excessive smallness, of the vasa def- 
erentia, as seen in the cut, especially from the epididy- 
mis to their entrance into the abdomen, we can 
readily conceive of the possibility of their obliteration. 
I have suspected it more than once in those individuals 
who after several inflammations of the testes and sper- 
matic cords have remained sterile. Art has as yet 
found no cure for this. 

9. Dilatation and Relaxation of the Vasa Deferentia, 
— There are several instances of this phenomena at- 
tending a sensible diminution of the excretion of se- 
men. M. Troussel Delvincourt has published in the new 
Journal of Medicine for October, 1820, a case of dis- 
ease of the right vas deferens where it had become two 
inches in diameter. When this affection can be de- 
tected, it may be treated by applying ice, preparations 
of lead, alum, and other topical astringents. 

10. Circocele. — A varicose tumor of the spermatic 
veins also may be large enough to compress the vasa 
deferentia and cause sterility. Although this circum- 
stance differs essentially from the preceding as to the 
nature of the tissue affected, the same topical remedies 
are useful ; but if after employing them for a long 
time, the tumors are large enough to arrest the excre- 
tion of the semen, we should not hesitate to remove 
them, as was practised by a surgeon in a case stated 
by Dr. Mouton {Diet, des Scien. Med., vol. v.) 



IN THE MALE AND FEMALE. 119 

The list of diseases of these organs might be still 
more enlarged ; those, however, already mentioned, 
are the principal ones, for which the attention of the 
practitioner and the remedial agents of the materia 
medica will be most frequently solicited. Further in- 
formation can be obtained by reference to Sir Astley 
Cooper on the Testes, and other surgical books with 
which our language has recently been enriched. 

§111. DISEASES OF THE ORGANS OF EMISSION. 

1. Special Lesions of the Prostate Gland. — No 
one has as yet studied the diseases of the prostate 
gland in respect to sterility. The researches of De- 
sault {(Euvres Chirurg,, vol. iii., p. 220), of Chopart 
Traits des Maladies des voies urinaires), of Sir Eve- 
rard Home {Diseases of Prostate Gland), and many 
other authors who have paid special attention to these 
maladies, have simply stated the obstacles they present 
to the excretion of the urine. Still, if we recur to the 
position of the prostate gland, its intimate relations 
with the urethra and seminal vesicles, it is easy to ap- 
preciate the influence they may have on the emission 
of the spermatic fluid independent of that of the urine. 
Morgagni {de sed» et causis morhorum, vol. ii.), who 
should always be consulted to enlighten the most ob- 
scure points of medicine, has collected on this topic 
the facts most in support of this truth. Thus he has 
found, by examining the bodies of several individuals 
who had been affected with retention of semen during 
life, engorgements of the prostate to a greater or less 



120 STERILITY CAUSES— TREATMENT 

extent, schirrous and cartilaginous indui:^tions, calcu- 
lous concretions, &c. We know, however, that these 
different lesions can not impair the function of genera- 
tion, except by exercising a mechanical action on the 
passages through which the seminal fluid is transmitted. 
For in the actual state of the science, we can not point 
out in what manner the defects in the secretion of the 
prostate gland are causes of sterility any more than we 
can determine the part taken by the functions of this 
gland in the generative process. 

It is not always easy to ascertain during life the na- 
ture of the alteration which impedes the emission of 
the seminal fluid : we can, however, fix with some de- 
gree of certainty the diagnosis of any swelling of the 
prostate gland by the symptoms which emanaet from 
the simultaneous derangement of the excretion of se- 
men, urine, and feces, and to the difficulty of intro- 
ducing into the bladder a sound which can readily be 
inserted as far as the prostate gland. 

Desault has also mentioned as a symptom of the 
varicose engorgement of this gland, the slowness at- 
tending defecation, the indolence of the tumor when it 
is compressed with the finger introduced into the rec- 
tum, and the absence of chills when the urine passes^ 
through the canal. 

There is no particular mode of detecting schirrous 
and cartilaginous indurations of the prostate gland un- 
less the swelling be so great that it may be felt by in- 
troducing the finger into the rectum. 



IN THE MALE AND FEMALE. 121 

It is still more difficult to distinguish the presence 
of calculous concretions in the body of the prostate 
gland, or in the ejaculatory ducts, because they are 
generally so small as not to increase the size of the 
gland. 

The difficulty of establishing rules of treatment 
necessarily depends on that of the diagnosis, or degree 
of alteration in the affected organ. When the tume- 
faction of the prostate gland appears to be simply the 
effect of the varicose engorgement of the vessels of 
this part, we may treat it v^ith some degree of success, 
by keeping the patient in the horizontal posture, added 
to the introduction of gum elastic sounds, the calibre 
of which must be gradually increased. The vessels 
are disgorged directly by applying leeches to the anus, 
while at the same time a new afflux of blood to the 
part is prevented by applying cold solutions of acetate 
of lead to the region of the perineum ; the bowels 
should be kept free by small cold enemata, being care- 
ful to avoid all efforts, which might impart to the ab- 
dominal circulation an impulse tending again to favor 
the engorgement. 

It is much more difficult to remedy schirrous and 
cartilaginous indurations of the prostate gland, so far 
as sterility is concerned, when the ejaculatory passages 
themselves take part in the affection. Nevertheless, 
after using sounds of gum elastic to preserve the con- 
tinuity of the urethra, we may employ,, with some 
prospect of success, especially if the disease be re- 
11 



122 STEIULITY — CAUSES — TREATMENT — 

centj mercurial frictions on the region of the perineum, 
plasters of hyosciamus- and belladonna, solvents taken 
internally, baths, and other general remedies ; but we 
can imagine that if the swelling of the prostate gland 
be attended with the adhesion of the parietes of the 
ejaculatory passages, sterility will be the necessary 
consequence, and will be incurable. For calculi ia 
the prostate, it is difficult to use other remedies than 
the employment of general means, especially baths 
and emollient cataplasms to the perineum. These not 
only allay the severe pains and inflammatory symptoms 
which usually attend this disease ; but if employed 
with perseverance, the calculi may be discharged from 
the urethra, and these foreign bodies have often been 
found at the mouth of the ejaculatory passages. M. 
Nauche has published the case of a literary gentle- 
man who, after experiencing for four months all the 
symptoms arising from the presence of foreign bodies 
in the prostate gland, was completely reheved after 
passing several calculi from the urethra.* In cases 
where these calculi project in the perineum, the same 
author recommends their extraction by cutting on the 
tumor. But, perhaps, in these cases we might follow 
the advice of Desault, that is, to operate in the man- 
ner indicated for the extraction of the vesical calculi, 
lest there might be an error in the diagnosis. 

* Diseases of Bladder and Urinary Passages : in which this author has 
thrown light on severEd important questioas. 



IN THE MALE AND FEMALE. 123 

2. Diseases of the Verumontanum. — Every one is 
familiar with this kind of uvula of the urethra, sit- 
uated behind the oblique orifices of the ejaculatory 
ducts, those of the prostate, and the glands of 
Cowper. It establishes a valve to prevent the reflux 
of their fluids into the bladder, at the moment of 
emission. 

Some females, in order to prevent impregnation, 
exercise a very strong pressure above the valve of the 
urethra, at the moment of emission, so that the valve 
yields, and the fluid enters the bladder instead of flow- 
ing through the urethra, and the semen follows a false 
direction. This cause of sterility is very serious, and 
difficult to cure. Since the last edition of this book, 
I have seen eleven cases of this character. The 
erections were more or less complete, but there were 
no emissions. There is but slight sensation of pleasure 
in this deplorable condition, which transforms the man 
into the eunuch. The mechanical remedies have not 
always obtained the success I desired. Generally, 
however, after a long and difficult course of treatment, 
there has been a more or less perfect seminal emission 
by the use of a pad fixed behind the prostate. 

The diseases of the verumontanum are most com- 
monly coincident with those of the prostate gland. 
They may appear, also, independent of these latter, 
especially after repeated or badly cured blenorrhoeas. 
The diseases which may occur under the influence of 



124 STERILITY— CAUSES TREATMENT 

such causes, and which it is important to study spe- 
cially, in regard to sterility, are the engorgement and 
induration of this part. 

Morgagni, de Blegny, and Sir Everard Home, have 
reported instances of sterihty, arising from these two 
kinds of alteration, which depend almost constantly 
on the obUteration of the orifices of the ejaculatory 
ducts. De la Peyronie (in the Mem, de V Academic 
de CJiirurgie^ vol. ii.) cites the case of a man who was 
unable to ejaculate, although the urine flowed freely. 
After death, a cicatrix was found on the posterior face 
of the verumontanum, which had changed the course 
of the ejaculatory ducts, so as to give the seminal 
fluid a direction different entirely from that of the ure- 
thra. This last circumstance may be simply the effect 
of the obliquity of the verumontanum, near the neck 
of the bladder, by the effort exercised by the semen 
on this part, when the urethra experiences any pressure 
at the moment of emission. I am now attending a 
gentleman lately married, who, having permitted this 
practice for many years, has completely lost the power 
of emission, although he still finds pleasure in sexual 
intercourse. 

It is as difficult to remedy these different causes of 
sterility, as to demonstrate their existence during life. 
In cases of engorgement and induration, there is no 
particular remedy, except those indicated for retention 
of urine from the same affection. (See the treatises of 



IN THE MALE AND FEMALE. 125 

Chopart, Desault, Louis, Petit, &c.) When a defect 
in the emission seems to be caused by a peculiar ar- 
rangement of the verumontanum, which has changed 
the direction of the seminal fluid, we may hope to 
restore to this latter its natural course, by the use of 
mechanical means, to overcome its tendency to retro- 
grade. Thus I have employed, and very successful- 
ly, a pad, which is attached to that part of the peri- 
neum corresponding to the prostatic part of the ure- 
thra, and which causes at the moment of coition a 
compression which prevents the flow of the seminal 
fluid into the bladder. 

3. Diseases of the Urethra. — The natural course 
of the semen may be interrupted by several diseases 
of the urethra, which either present real obstacles, or 
which change the direction necessary to fulfil the 
object of sexual intercourse. When speaking of 
hypospadias, I have already mentioned strictures of 
the urethra as causes of these two phenomena, and 
in order not to return to a subject, the details of 
which belong to the history of diseases of the urinary 
passages, I shall simply add some remarks, which 
seem to be more directly connected with the object of 
this book. 

When the obstacles which have caused the forma- 
tion of urinary fistulae have been treated with such 
success as to establish the continuity of the urethra, 
the fistulous opening may give a passage to the urinary 
11* 



126 STERILITY — ^CAUSES TREATMENT 

and seminal fluids, and thus frustrate the purposes of 
nature. This occurs principally in those old urinary 
fistulae, the parletes of which are covered with an acci- 
dental mucous membrane, and especially when the 
opening has assumed the appearance of a natural ori- 
fice with loss of substance In which there is no hope of 
cure. In the treatise of Chopart on diseases of the 
urinary passages, and In all the collections of military 
surgery, we find a great many cases of this character, 
which can only be treated by such mechanical means 
as tend to restore the urine and semen to their natural 
channel. In many cases I have used a layer of gum 
elastic so thin as not to impede the act of coition, and 
formed In such a manner as to close all access to the 
semen through the fistulous opening at the time of the 
emission. It is but a little while since I had occasion 
to prove the efficacy of this remedy by the following 
case. 

A colonel of cavalry, D , had been affected 

for a long time with a urinary fistula at the base of the 
penis, the result of several badly treated blenorrhoea : 
there was no hope of curing the opening which gave 
passage to the urine and semen. But still he mar- 
ried, and several months afterward came to consult me. 
After recommending the use of gum elastic sounds, 
the calibre of which should be gradually increased to 
favor the enlargement of the urethra, I applied over 
the fistulous opening a layer of gum elastic, kept In 
place by two ribands, attached to the gum, and by two 



IN THE MALE AND FEMALE. 127 

Others which passed round the pelvis. This simple 
contrivance had the desired effect ; for nine months 
afterward his lady was delivered of an infant. I might 
mention many other cases of this kind seen by M. Es- 
parron, and still more recently by Dr. Nauche. 

4. Diseases of the Muscles which contribute to the 
Emission of Semen. — The levatores ani, bulbo caverno- 
sus, and transversus perinei, the convulsive action of 
which must complete the ejaculation, may lose their 
motility and become paralyzed by the advance of age, 
the abuse of venereal pleasures, previous diseases, as 
apoplexy, hermiplegia, poisoning by carbonic acid gas, 
&c. We have also known several persons to be im- 
potent from wounds of the perkieum, with loss of sub- 
stance. 

It is not equally easy to remedy sterility arising from 
these different causes. There is less prospect of cure 
when it comes from age, or from the enervating effects 
of masturbation, as it is then attended with true anaph- 
rodisia, that is, with a want of sensibility and proper 
flow of blood to the penis. (See Anaphrodisia, p. 84.) 
Nevertheless after subjecting the genital organs to a 
period of rest, and having repaired, by all suitable 
means, the exhausted strength, we may use frictions 
of the perineum with spirituous and stimulating lini- 
ments, baths, douches of sulphurous and ferruginous 
mineral waters, and especially the employment of ma- 
laxating shampooing which has so powerful an effect in 
most of these cases, and also on the relaxation or de- 



128 STERILITY CAUSES TREATMENT — 

bility of the sphincters. Medication on the occipital 
protuberances or the nucha will be beneficial in some 
cases. Baillou recommends old men to indulge in in- 
tercourse in the morning, because then the bladder 
being full, compresses the seminal vesicles, and assists 
the action of the ejaculatory muscles ; and it is for the 
same purpose that I have recommended to introduce 
into the rectum a cyHnder or suppository of gum elas- 
tic. 

An Austrian general of cavalry, who was addicted 
to all kinds of excesses in his youth, was unable to 
have an emission at the age of fifty years, although 
erections took place. Being married at this period, he 
felt more than ever the necessity of finding aid for his 
impotence, and came to consult me : the use of the 
cylinder, added to fulness of the bladder, enabled him 
to fulfil the act of marriage, and to obtain its most de- 
sired fruits. 

If muscular debility be the consequence of any cer- 
ebral affection, the physician should first attend to this 
cause, and if he be fortunate enough to treat it suc- 
cessfully, he will also find powerful remedies for the 
local disease in the use of stimulating liniments, 
douches, and particularly in the application of moxas 
and cups to the region of the perineum. 

Fissures of the anus, and the spasmodic closing of 
the sphincters, are diseases which impede or render 
painful the copulative functions : their treatment con- 
sists in a mild, diluent regimen, emollient fomentations, 



IN THE MALE AND FEMALE. 129 

injections of infusions of seeds of cucumbers, quinces, 
and melons. Baron Boyer derived great advantage 
from the following pommade : hog's lard, iix ; juice of 
houseleek, nightshade, and oil of sweet almonds, of 
each 3jv. This pommade is melted at a gentle heat, 
and two or three spoonfuls are injected into the rectum, 
and this injection is repeated two or three times daily. 

The introduction of long and large rolls of lint 
smeared with a mild, opiated pommade may also be 
beneficial. These means are almost always insufficient 
to cure these diseases, and often even to diminish suf- 
fering. Experience, however, and the skill of our 
great modern surgeons, have taught us the curability 
of this kind of lesions. It consists in one or two 
deep incisions, which Boyer made with a single cut 
of the bistoury. He took a bistoury, the very narrow 
edge of which was straight and rounded at its extrem- 
ity, and introduced it flat, directing it with the index 
finger of one hand ; he carried it into the rectum, and 
with one cut divided the intestinal membranes, the 
sphincters, cellular tissue, and integuments. He thus 
formed a triangular wound, the apex of which looked to 
the intestines, and the base to the skin. 

By following these indications, we have relieved 
constrictions of the sphincter with or without fissure, 
which renders coition impossible by the terrible pains 
caused by the erections ; one only, or a double incision, 
one on the right, the other on the left, have constantly 
cured these lesions. 



130 STERILITY CAUSES TREATMENT 

When sterility is produced by a wound, with loss 
of substance of this part, art can only suggest the me- 
chanical means proposed. 

§ IV. DISEASES OF THE ORGANS OF CONSERVATION. 

Diseases of the seminal vesicles still belong almost 
entirely to pathological anatomy : hence we shall only 
mention them here to make known the difSculties of 
their diagnosis and treatment. Morgagni, Le Blegny, 
Littre, Lapeyronie, Desault, &c., have cited instances 
of steriHty produced in different alterations of these 
organs, inflammation^ suppuration^ induration^ and ossi- 
fication* But as they have only been examined after 
death, we can not lay down any precepts by which 
they may be detected and treated. A fixed pain in 
the perineum increased by coition, especially at the 
moment of emission, dysuria without any other trou- 
ble in the urinary apparatus, tenesmus independent of 
any other morbid phenomena of the large intestine, 
the diminution or the suspension of the seminal ex- 
cretion, &c., may, however, give rise to the suspicion 
of some pathological affection in the vesiculae semina- 
les, but it is difficult to determine its nature, and to 
establish other rules of treatment than the use of gen- 
eral means, such as hip-baths, emollient injections, 
warm drinks, demulcents, &c. In some cases, also, I 
have used with success setons in the perineum, which 
I have kept suppurating for several months. Slight 
moxas have also been beneficial. 



%k 



IN THE MALE AND FEMALE. 131 

ARTICLE II. 

Slerility dependant on General Causes Inherent in the Constitution 
of Man. 

Most of the causes of sterility we have hitherto 
studied, are more or less easily detected, and yield 
more or less to treatment ; but this is not true of those 
now to be considered. Here, in fact, the etiology of 
sterility becomes obscure, and sometimes evades our 
perceptions entirely. Still, to omit nothing on this 
point which can be learned by science or observation, 
we refer to two principal divisions all the causes which 
may give rise to this kind of sterility. Thus we study 
successively — 1, under the title physiological disposi- 
tions those belonging to the ages, temperaments, idio- 
syncracies, &c. ; and 2, under that of pathological 
dispositions, general diseases, as scorbutic, scrofulous, 
and venereal cachexies, &c. 

§ I. PHYSIOLOGICAL DISPOSITIONS. 

1. Ages. — Man is not fit for generation at the mo- 
ment he reaches puberty. The simple transition from 
boyhood to youth can not impart this power, as some 
physicians think. In fact, in order that the secreted 
semen may be prolific, it must be elaborated by organs 
which have attained their full development. Now if 
there be any exaggeration in the opinion of BufFon, 
who fixes this period at the age of twenty-four years, 
we think it can not generally occur before the age of 
twenty years, as Linnaeus imagined. In fact, we see 



132 STERILITY CAUSES TREATMENT 

many individuals give proof of fecundity before that 
time ; but the fruits are generally feeble and languishing. 

Man preserves his genital powers longer than wo- 
man ; but it would be wrong to think that he possesses 
all the conditions relative to generation, because he 
gives some signs of reproductive life, at an age of 
decrepitude. Finally, there is no fixed limit for the 
beginning or end of the genital power in man. It 
results from a concurrence of circumstances, which 
impress on him their type of life and sensibility. 
Thus, in the man whose puberty was precocious, and 
whose reproductive life was very active, the amatory 
passion ceases to exist long before him whose marriage 
has been retarded by education, or by private habits. 
Hence, we must have regard to the general disposition 
of the economy, when the genital system is exposed 
to any excitement. We are not even authorized to 
use aphrodisiac medicines, unless the impotence occurs 
in patients who have acquired their entire develop- 
ment, without feeling the necessity for reproduction, 
or in those whose feehngs have been chilled by age, 
while their constitutions have remained unimpaired. 

Those individuals who may be rendered sterile by 
so many different causes are nevertheless embraced 
under the same physiological conditions, and should 
be placed under the influence of the same therapeutic 
remedies ; for if there be need of stimuli to vivify or- 
gans so very inert, these stimuli are required to excite 
a sensibility which is daily extinguished by age. 



IN THE MALE AND FEMALE. 133 

A Polish nobleman, who had abused venereal pleas- 
ures in early life, had entirely lost his virile powers at 
the age of thirty-five years ; he had consulted succes- 
sively, on this subject, Hufeland, Osiander, Caro, and 
lastly, the celebrated Tommasini, who directed him to 
me. The prince was then forty-five years old, and 
seemed bent under the weight of years. He com- 
plained of a severe pain along the spinal marrow, 
added to extreme difficulty of walking. All the or- 
ganic functions, and especially the digestive functions, 
were much changed. Attending at first to the state of 
exhaustion, which was evidently the primary cause of 
impotence, I advised the patient to absent himself en- 
tirely from society, to prepare for an anti-anaphrodisiac 
treatment. He lived with some friends for several 
months, in a small country house, where his time was 
divided between hunting, fishing, and gardening; 
adding to the influence of these remedies, a regimen 
essentially analeptic, and which was continued for 
about six months. I then advised for him the follow- 
ing syrup, which I added to a weak tisan of chicory, 
in doses of four or fiv^e spoonfuls, daily : — 
Nut of the Cacao Theobroma, ^ iv, 



Husk of Vanilla, 


iji, 


Ginseng root, 


5 V, 


Root of Jean Lopez, 


3iij, 


Gentian root, 


5 is, 


White Sugar, 


Ibiv, 


Water, 


q.s., 


Tincture of Saffron, 


3ij, 


12 





134 STERILITY CAUSES^ TREATMENT 

All of which were mixed. Each day I directed him 
to rub the spinal column, the inner part of the tkighs, 
scrotum, &c., with the usual anti-anaphrodisiac lini- 
ment. (See the Pharmacologia.) The prince wore, 
night and day, an asterasic girdle, which contained 
the tincture of ambergris, and the essential oil of roses. 
The patient began to experience the good effects of 
this treatment, when he was obliged to suspend it on 
account of the coldness of the weather. I advised 
him to spend part of the winter at Nice, where he 
resumed his treatment, which was attended with the 
desired result. The prince has since married, and has 
now three children. 

2. Temperaments. — The temperaments, particular- 
ly, exercise a very manifest influence on the degree of 
energy of the genital powers. We know that amo- 
rousness is usually attended with the bilious and ner- 
vous temperaments, while highly lymphatic constitu- 
tions are often accompanied with a kind of frigidity 
which renders them sterile. The same remark has 
also been made in regard to individuals who are 
extremely fat. It seems that under these circumstan- 
ces, all the vital forces have left the genital organs, to 
concentrate their influence on some particular system, 
which they develop in excess. Those prolific flowers 
which become sterile because their stamina are changed 
into petals by an excess of nourishment, present us 
with the picture of this kind of sterility in man. So 
too there are athletic constitutions, which are attended 



IN THE MALE AND FEMALE. 135 

With a kind of aprthv of the sexual organs, as if the 
whole vital power 'vas then consecrated to the devel- 
opment of the muscular system. 

In accordance with the same laws, the genital appa- 
ratus may itself become a centre of vitality more or 
less active at the expense of the rest of the organiza- 
tion. This superabundance of life in the sexual or- 
gans, which the learned Halle terms the genital tern- 
perament, because it characterizes a greater aptitude to 
generation, is often hereditary, or the fruits of a pre- 
mature education, bad habits, &c. 

In considering the temperaments under this last 
point of view, we observe also that some individuals 
are sterile from a want of the genital temperament, as 
there are individuals in whom the sexual organs are 
struck with a kind of original inertia, generally char- 
acterized by a slight degree of development in the pe- 
nis, its almost constant flaccidity, the laxity of the 
scrotum, incontinence of urine, sour smell of the per- 
spiration, fine tone of voice, &c. 

The sterility dependant on a general disposition of 
the temperament is undoubtedly one of the most difB- 
cult to treat. The ancients recommended to combine 
one of these temperaments with one of another kind, 
so as to render marriage fecund. Thus it has been 
recommended that thin men should marry with fat 
women, and hght men with dark women, and vice 
versa. This opinion which has served for a basis for 
the author of the Sttidies of Nature to establish his 



136 STERILITY CAUSES TREATMENT 

system of contrasts in love, became, in fact, entitled to 
some degree of probability from the numerous facts he 
has collected. In cases of constitutional sterility, art 
may also have recourse to the different means for ex- 
ercising the different organic systems, and particularly 
the genital system. Thus exercise in the country and 
in a season when the passions show themselves with 
the most energy, the employment of aromatic vegeta- 
bles, spirituous liquors taken with reserve, aphrodisiac 
remedies administered with judgment, liniments of 
hartshorn and cantharides, the use of electricity, &c., 
may be particularly valuable in the treatment of this 
kind of sterility. But it would be more plausible to 
count on the success of these remedies in cases of lo- 
cal impotence, or those resulting from a defect of 
genital temperament. (See Local Anaphrodisia.) 

3. Idiosyncrasies. — To make known the influence 
which different individual idiosyncrasies may have on 
the genital powers, we must dwell for an instant on the 
sense which must be attached to this word considered 
under the head of sterility. Every individual has a 
a mode of sensation, of living, and of suffering ; and 
this disposition which is inherited, or which is acquired 
by the different hygienic circumstances, niay impress 
on the sensibility of the genital organs, a fashion and 
degree of afFectibility which it is sometimes difficult to 
refer to its true source. I know of no case which will 
show better the influence of these causes on the geni- 
tal powers of man than the following fact* 



IN THE MALE AND FEMALE. 137 

M , a peer of France, had been obliged to 

leave France, when twenty years old, to avoid the 
dangers of the revolution. He went to New Orleans, 
where he lived for nearly fifteen years, and adopted 
the manners of the country. In 1814, he returned to 
France, and wished to change his course of life, 
eating indiscriminately of all kinds of meat at table ; 
but he soon perceived that his genital powers were 
faihng. Being consulted under these circumstances, 
I prescribed an anti-anaphrodisiac treatment which was 
unsuccessful. Mr. M. having desired to renew his old 
regimen, I advised him to use savory, asparagus, herb 
bennett, and especially ginseng and truffles ; and rec- 
ommended the loins and genital parts to be rubbed 
with a liniment of ambergris. He took in the morn- 
ing a bowl of warm milk and seven or eight spoon- 
fuls of mush ; at noon, a salad with meat ; in the 
evening, several dishes of vegetables with game. Mr. 
M. continued the same course for several years, and 
had the full possession of his virile powers : but it is 
remarkable that he lost them when he suspended the 
use of this diet for several days. 

In many cases sterility is connected with a kind of 
apathy of the sensitive, with an inertia of the genital 
powers, as w^e shall see in the following cases. 

M. G., of Lyons, merchant, well formed, married at 

the age of twenty years a young lady to whom he had 

been very fondly attached from his youth. After two 

years of happy union he had the misfortune to lose his 

12* 



138 STERILITY — CAUSES TREATMENT 

wife in difficult labor, and the grief for this loss caused 
him to absent himself from society for several /ears. 
When thirty-eight years old, his parents wished him to 
marry again. He then perceived that his genital or- 
gans were inert. For this he consulted Dr. Montain, 
of Lyons, who recommended travelling and thermal 
baths, which were followed for several months without 
success. He was recommended to me by the presi- 
dent of Chenevas. 

M. G. was then forty-one years old, enjoying good 
health, and was even fleshy : all his functions were 
performed regularly, but the sexual parts were con- 
stantly flaccid. The patient was put on the use of 
some warm baths, a diuretic tisan; I then recom- 
mended the congester, the application of which was 
very painful. For about a month the blood penetra- 
ted with difficulty into the corpus cavernosum. Oily 
frictions of the penis, emollient cataplasms, and the 
use of the congester two or three times daily, gradu- 
ally produced feeble erections. After the employment 
of this instrument, abundant pollutions supervened 
during sleep. Emollient fomentations and hip-baths 
removed this factitious irritation of the tissue of the 
ejaculatory vessels. M. G. recovered in a little time 
the exercise of his genital powers, and is now the fa- 
ther of two children. 

Case 2. — A young man from Brussels, twenty-four 
years old, well made, tall in stature, and having the 
genital organs largely developed, had committed so 



IN THE MALE AND FEMALE. 139 

many excesses in his youth, that when twenty-two 
years old, he lost his virile powers. He sued in mar- 
riage for the hand of a young lady to whom he was 
much attached, and his mind was constantly directed 
to her charms. From some symptoms of insanity, he 
was placed in the asylum of Esquirol, and there the 
treatment subdued, to a great degree, the violence of 
his passion. After being under the charge of Esquirol 
for one year, he left the maison de sante, and went to 
Paris with a friend. Occupation and employment 
soon caused him to forget this young lady. His sex- 
ual desires, however, returned, but he was much sur- 
prised at finding that his virile powers were lost. To 
regain them he tried several remedies, but ineffectu- 
ally. Finally he was referred to me by Dr. Barbier, 
of Brussels. 

Treatment. — Asterasic frictions to the lower extrem- 
ities ; baths, shampooing, the use of anti-anaphrodisiac 
substances ; then horse exercise, &c. After a month 
and a half of treatment, the application of the conges- 
ter, v>^hich was at first very painful. Much time and 
perseverance were required before this instrument 
could be used with comfort. I, however, brought 
blood into all parts of the cavernous tissue. After 
fifteen months of varied treatment, order and harmony 
were restored to all the functions. 

Dr. Mortcourier recommended to me two young 
men, whose genital functions were paralyzed. One 
was twenty-seven years old, and was extremely timid 



140 STERILITY CAUSES TREATMENT 

at the thought of sexual intercourse, although on the 
eve of marriage. His genital organs were small, and 
the prepuce presented a phymosis, for which I operated. 
The action of the congester increased the length of 
the penis about one fourth. The erections became 
full, and his marriage was followed by a family. 

The other was about twenty years old, small in 
stature, but strong ; the genital organs being largely 
developed. He had abused his genital organs a good 
deal, and suddenly they lost their power. I used ab- 
lutions of cold water, with the tincture of benzoin ; 
frictions to the kidneys ; asterasic baths, and finally, 
the application of the congester. In some months, this 
young man nearly recovered his virile powers. He 
went into the country, where he again lost the use of 
his organs from excess. On his return to Paris, we 
resumed his treatment, and his genital powers returned. 
The application of the congester caused powerful erec- 
tions, and has constantly remedied this impotence. 

In 1826, B. T., a young man twenty-eight years 
old, well brought up by a bishop, who had always led 
a virtuous life, married a young lady to whom he was 
fondly attached, and was surprised to find his virile 
powers were lost. For ten days, he made all possible 
efforts to attain his purpose ; erections sometimes 
came on at night, but as soon as he attempted to ap- 
proach his wife, they subsided. The testes were 
small, round, tender to the touch ; the cord was pain- 
ful, granular, thin ; there was paraphymosis, arising 



IN THE MALE AND FEMALE. 141 

from a very short frenum ; after the operation, full 
erections were caused by asterasic ablutions, and the 
appHcation of the congester. After fifteen days, he 
was able to perform his marriage duties. 

I have attended many others for the same cause. 
M. M. was married when young, but was impotent. 
Although his mind was filled with voluptuous images, 
the erections subsided as soon as he attempted inter- 
course. Asterasic frictions to the kidneys, baths, ab- 
lutions, sinapised pediluvia, and the application of the 
congester brought on erectility of the penis. When 
the erection was slight, some spoonfuls of anti-anaphro- 
disiac syrup rendered it complete. 

The same treatment has constantly succeeded in 
similar cases. 

^ II. PATHOLOGICAL ALTERATIONS. 

Every morbid state may compromise, more or less, 
the phenomena or product of generation, either by 
causing real impotence, or by exercising some influ- 
ence on the secretion of the semen. 

None of the general diseases or diatheses, consid- 
ered by some authors as a cause of steriHty, seem to 
have a sedative action on the sensibility of the geni- 
tals. The genital organs are only affected with iner- 
tia, when they share the debility of the other living 
systems. So that impotence from these causes is sel- 
dom seen, except when the muscular strength is evi- 
dently enfeebled. It is thus that scurvy, having con- 



142 STERILITY — CAUSES TREATMENT 

tinued for some time, often renders the persons affected 
with it, impotent. The venereal, scrofulous, cancer- 
ous diatheses, &c., may also in some cases extend their 
debilitating effects to the reproductive apparatus, al- 
though the fecundity of those affected with them, is 
attested by too many instances. Most chronic diseases 
produce in the long run the same effect. None of 
them, however, seem to be attended with increased 
energy of the genital system. We know, for instance, 
that amorousness is seen commonly in those affected 
with phthisis, as if the centre of. heat, which consumes 
the principal organs of individual life, extended all its 
activity to the reproductive system. 

So, too, we see after acute diseases convalescents 
are extremely amorous, which cases, however, must 
not be confounded with the preceding. Here, in part, 
nature is simply occupied with the preservation of the 
individual, and seems to have forgotten during the 
course of the disease all functions relating to the life 
of the species, and it is not generally till the moment 
of convalescence and of return to health, that the vi- 
rile powers resume their activity : sani hominis est ap- 
petere et ad earn valere et sobolem procreare. We are 
ignorant how far the different diatheses or general dis- 
eases may render copulation unproductive by altering 
the secretion of the semen. We only know that this 
fluid is sometimes changed in its color, although we 
are ignorant to which of the fluids composing this 
secretion, to attribute the chano;e. We beheve it has 



IN THE MALE AND FEMALE. 143 

been remarked to have a red or blackish color in hy- 
pocondriases, and a fetid odor in those subject to epi- 
lepsy* Aristotle had noticed that the semen loses its 
prolific power with its consistence, where he says : 
'* If the male semen floats on water, it is unproduc- 
tive, while if it sinks, it possesses its procreative pow- 
er."t In fact, observation proves that those individ- 
uals in whom the semen has become fluid and trans- 
parent by excessive losses, are generally sterile. 

If we could remedy sterility arising from some of 
the diatheses, it would be done by directing all our 
remedies to the nature of the aifection. There, in 
fact, the physician must terminate his efforts, and in 
cases of incurability, say with Jeremiah, addressing 
the people of Israel: *' Rejoice, thou barren, that 
bearest not !" 

* Ephem. Nat. Curios., dec. 1, Ann. 1, Obs. 63. 
t De Generat. Anim., lib. iv. 



144 STERILITY CAUSES TREATMENT 



SECTION II. 

STERILITY IN THE FEMALE. 

Physiological Remarks, 

Woman is the second part of the social tie which 
she forms simultaneously with man, to produce a com- 
plex whole. The pivot of all human felicity, she be- 
comes the centre of the family; the emblem of man, 
by her conjugal necessities, and the intimate relations 
she contracts with him, nature has provided her abun- 
dantly with all the qualities indispensable for the wants 
of life, and for social happiness. 

It does not enter into our plan to state the immense 
advantages which the female brings into the conjugal 
union ; many illustrious writers have treated of this 
subject in eloquent treatises ; and Roussell, Legouve, 
Virey, and many others no less enlightened, have 
stated the characters, physical beauties, and moral 
qualities of females. We are to consider her here 
only in respect to the causes or impediments which 
obstruct fecundation. 

The female child grows up with the male child, and 
the distinctions of sex are not regarded. When ar- 
rived at the age of puberty, nature makes in her great 
physical changes. She is moved, instinctively, by 
sentiments of shame, modesty, and timidity, of which 
she has hitherto been ignorant. She is more timid in 



IN THE MALE AND FEMALE. 145 

her thoughts and actions ; she seeks soHtude, and pre- 
fers quiet to the noisy plays of childhood. It seems 
that nature directs her, in all these phenomena, to 
learn the important part which she is to fulfil afterward. 
She soon perceives the remarkable difference which 
exists in the tw^o sexes — it is the commencement of a 
beautiful organization — it is the female, who now as- 
sumes her legitimate attributes. Hitherto, the young 
girl has w^orn her clothing loosely, without fatigue, and 
has moved about freely ; her organs and limbs are 
developed vigorously, and without constraint, without 
effort. In the new existence which all these changes 
bring, the clothing of infancy is removed, and she is 
obliged to wear corsets, under the pretext of acquiring 
a shape, in which, generally, but Utile discernment is 
shown ; and the poor child being thus imprisoned, 
as it w^ere, suffers. If there be slight deviations in 
some parts of the thorax or dorsal spine, stronger 
whalebone, plates of iron, and steel, and leather, are 
used, and she is subjected to still greater annoyances. 
The respiration is difhcult, the circulation compressed, 
her motions are constrained, and many symptoms ap- 
pear, such as loss of appetite, disturbed and inter- 
rupted sleep, and palpitations of the heart, which is 
sometimes hypertrophied. The organs are displaced, 
especially the uterus, which is pushed into the cavity 
of the pelvis. How many instances could be cited, 
where these cruel and pernicious manoeuvres have 
excited sterility in females. How many times, too, 

13 



146 STERILITY CAUSES TREATMENT 

have they caused organic changesj which have been 
attended with fatal consequences ? We insist that it 
is absolutely necessary to bring up the young female 
under such physiological conditions as will not inter- 
fere with the functions which nature has devolved upon 
her, and especially those of reproduction. I am aware 
that the defects of our social organization obhge us to 
modify the normal rules or precepts of education, ei- 
ther physical or intellectual. But since the poor 
female is condemned to submit to these irregularities, 
we must at least make them as light as possible. 

What a remarkable difference between the country 
female, who is robust and strong, and in perfect health, 
and who combines all the elements for rearing a nu- 
merous family, whom she nurses and brings up with 
vigilance and care (and seldom do we find a sterile 
woman in this class), while the city female is often 
deprived of the pleasures of maternity, by most of the 
causes we have mentioned. Finally, since the females 
of our cities are obliged to submit to the requisitions 
of the world, they are forced to fulfil a great many 
duties. They are obliged to be amiable, kind, and 
gracious, and possess all the treasures of a good wife^ 
to captivate and please. A sweet voice, the tones of 
the piano, the vibrating cords of the harp, and even 
those of a sweet guitar, have produced their effect on 
more than one husband. It is by the happy feelings 
of the heart that the chords of love in the suiter are 



IN THE MALE AND FEMALE. 147 

touched ; the organs yield to the sweet attractions of 
nature, and thus its work is accomplished. 

The causes of sterility in the female are much more 
numerous than those belonging to the other sex — 
which has led an author to remark, that we find thirty 
sterile females for one man who is impotent : Oritu?^ 
sterilitas j^lerumque foemi7iarum vitio; triginta enim 
mulieres steriles in singulos vij'os imjpotentes si divisio 
Jieret inveniri jpossunt.^ We shall here refer likewise 
to two principal heads : that is, to diseases of the gen- 
ital system, and to the physiological and pathological 
genital arrangements, all the circumstances which may 
oppose copulation and fecundation. 



ARTI CLE I. 

Diseases of the Genital System considered in the Female in 
resjpect to Sterility* 

% I. DISEASES OF THE ORGANS OF UNION, OR 

DEVIATIONS OF FORMATION COMMON TO ALL 
PARTS OF THE VULVA AND VAGINA. 

The deformities in the vulvo-vaginal canal are nu- 
merous ; it may also be affected with various patho- 
logical lesions. Both may injure or impede the work 
of reproduction. The examination which we are 
about to make, will show under what circumstances 
art is necessary, and even indispensable, to aid the 

* Manninghan, in Artis Obstetr, Comp, ; Sect, de Conceptione. 



148 STERILITY CAUSES- — TREATMENT 

necessities of nature, in fulfilling the functions of gen- 
eration. 

1. Excessive Length of the Clitoris.— Some authors 
have classed the unnatural development of the clitoris 
among the causes of sterility : in fact, if we consider 
that those females who possess this abnormal organiza- 
tion which, in its length and size, equals and even ex- 
ceeds the dimensions of the male genital organ, are 
more disposed and addicted to the pleasures of love, 
they experience an inevitable necessity of producing 
an action in this part where all the voluptuous sensa- 
tions are situated ; they, however, are not disposed to 
sexual congress, but to sohtary indulgences. When 
duty obliges them to yield to conjugal necessities, we 
find an abnormal perturbation, either from an organic 
arrangement which is developed by this depraved taste, 
or by the impediment and even suffering during the 
lawful functions of love : we can then imagine that the 
proper genital organs being deprived of the super-ex- 
citement caused by the act of coition, the prolific mat- 
ter can not be absorbed by the uterus. 

The only remedy for this monstrosity consists in 
amputating the clitoris. This amputation is performed 
with strong scissors curved on their edge, or rather 
with a long and short bistoury : the arteries should be 
tied up, and a proper dressing appHed. Strangulation 
has been abandoned in consequence of the extreme 
pain it causes, and the slowness of its operation. 

We have all read the history of that Roman lady 



IN THE MALE AND FEMALE. 149 

who was surprised by her husband while engaged in 
ilhcit pleasures. Enraged, he cut off the chtoris with 
his sword, and thus rendered her fruitful after eight 
years of a sterile marriage. I shall relate, on this oc- 
casion, the two following cases. 

Case 1. — In 1814, there was brought to my maison 
de sante, in Bologne, a young girl, twenty years old, 
who had been married for several years without having 
any family. She indulged in the fatal habit of clito- 
rism, which she contracted in early life, and practised 
it to such a degree that she was brought to the last 
stage of marasmus. Pelletan and Dubois were con- 
sulted several times on this subject, and finally decided 
that the removal of the clitoris was the only mode of 
arresting this practice. The operation was performed 
with one cut of the bistoury : she regained her health, 
and even after became a mother. 

Case 2. — Last year, while at Frankfort on the Maine, 
M. S., who had been married for five and a half years, 
requested me to examine his wife, aged about twenty- 
five years, whose clitoris measured four inches and 
some lines ; its turgescence in the genital act was 
a great impediment. M. S. caressed his wife with 
great repugnance, while she felt extreme disgust 
for her husband whose embraces were very painful. 
The desire of having a family induced both of them to 
consent to the amputation of the clitoris, which was 
performed easily and without any bad symptom. 
Twenty-five days afterward. Mad. S. was much sur- 

13* 



150 STERILITY CAUSES— TREATMENT 

prised at unknown feelings caused by sexual congress ; 
in two months the menses stopped, and she became 
pregnant. 

Abnormal formations in some cases have caused in- 
flammation of the clitoris. I have seen those which 
were very large : they are to be cured by antiphlo- 
gistic remedies. 

The clitoris may likewise be affected with carcino- 
ma, which will interfere with the generative process. 
This disease usually commences at the end of the 
glans. As soon as its character is well ascertained, 
the organ should be removed in the same way as the 
penis, is. Hemorrhage may be arrested by the cau- 
tery, or by a ligature. If the disease extend further, 
the base of the clitoris might be detached from the pu- 
bic arch, as was done successfully by Dupuytren in a 
a case where he removed all the external genital or- 
gans, which were carcinomatous. 

The fourchette, or the perineum, may be lacerated 
by accidents or by a difScult labor. The lesion of the 
fourchette is by no means serious, and rest and clean- 
liness will effect a cure ; but that of the perineum is 
not only disagreeable, but is injurious to the functions 
of reproduction : hence every mode should be adopted 
to keep the divided parts together. 

2. Deviations in the Formation of the Nymjphce. — 
The nymphae, or internal labia, are sometimes very 
large, becoming several inches in extent. This for- 
mation is very inconvenient to the female, and seriously 



IN THE MALE AND FEMALE. 151 

impedes and afterward prevents reproduction. It Is 
rarely seen in Europe ; for during the twenty years I 
have attended to the subject of sterility, I have known 
but three cases. A lady from Rio Janeiro, who had 
been married for some years without bearing children, 
had two very large nymphas which projected between 
the thighs. She w^as extremity repugnant to sexual 
intercourse vrhich caused intense pains and chills. 
The desire of becoming a mother caused her to sub- 
mit to an operation, which I performed with a bistoury, 
cutting down the nymphae as much as possible ; the 
hemorrhage was arrested by compression, and no bad 
symptom followed. The next year this lady was con- 
fined with a daughter. 

At the close of 1833, a girl, twenty-two years old, 
was presented to me, whose parents were anxious 
should marry; one of the nymphae was very long, 
and she wished to have this removed before taking a 
husband. I performed the operation, and removed a 
labium, the greatest diameter of which was more than 
seven inches. Last October I performed the same 
operation on a female twenty-two years old. 

When the nymphas have congenital or accidental 
adhesions, coition can not occur. They should be di- 
vided with a bistoury, and a proper dressing applied. 

As the diseases or lesions affecting the vulvo-vagl- 
nal canal are described in special treatises, it is useless 
to mention them here. 

3. Absence of the Vagina. — Instances of this mal- 



152 STEFvTLITY CAUSES TREATMENT 

formation are found In many authorsj among others in 
Haller and Vicq d'Azyr. Richerand. too, in his 
Physiology (vol. ii., p* 347), has given the history of 
a female in whom this organ was deficient. This de- 
formity does not of itself form a case of incurable 
sterility except by the absence of the uterus with 
which it is generally attended. 

4; Narrowness of the Vagina. — Natural narrowness 
of the vagina is a circumstance which may render the 
consummation of marriage more or less dlfScult, but 
which can not be considered as a cause of impotence. 
In fact, it is extremely rare, that coition alone does 
not cause in time the dimensions requisite for the re- 
productive act. This is not true of accidental con- 
tractions resulting from a cicatrix after a wound with 
loss of substance, or an inflammation w^hich causes in- 
duration and thickening in the region of the parietes 
of the vagina so as to render coition impossible. 
This accident also may be the effect of a kind of har- 
dening, arising from the use of astringents which some 
fem.ales abuse. M. Murat, in the Diet, des Sciences 
Medicales, vol. L, vi., p. 479, has mentioned the history 
related by Chambon, of a female, twenty-six years 
old, in wdiom, from using astringent injections, the va- 
gina had become callous to such an extent as to pre- 
vent the introduction of the penis. The vagina also 
may be contracted in a part of its extent, or in the 
whole of its length by osseous tumors near it, or by 
syphilitic, schlrrous, carcinom.atous excrescences, &c.j 



IN THE MALE AND FEMALE. 153 

developed in the texture of the vagina. Helsser and 
Morgagni have known the vagina to be contracted by 
natural and accidental transverse bands which presented 
a kind of fleshy or membranous bands to the introduc- 
tion of the penis. It is also known that the mem- 
brane of the hymen may become so dense as to op- 
pose invincible resistance to the efforts of the husband. 

When the specific causes which have given rise to 
contractions of the vagina have been treated by gene- 
ral and local remedies, w^e may use tents of prepared 
sponge, oily injections, and emollient hip-baths, &c. ; 
but it is very difficult to cure those arising from bony 
tumors developed in some part of the pelvis. Although 
it has been asserted that the female may conceive not- 
withstanding the obstacle of the hymen to the intro- 
duction of the penis, it seems to us, however, always 
necessary to divide the part when the vagina can not 
be dilated sufficiently in the natural way. 

5. Obliteration of the Vagina. — The external ori- 
fice of the vagina may be closed naturally by aa im- 
perforate hymen, or by the presence of a second 
membrane which arrests the menstrual discharge, and 
renders the act of coition impracticable. Ruysch,* Bau- 
delocque,t Pelletan,t and Chaussier,|| &c., have rela- 
ted instances of this malformation which is remedied 
by making a crucial incision in the membrane causing 
the obstacle, and by introducing a tent of Hnt spread 

* Thesaurus, vi No. 86. f Traite des Accouchemens. 

t Clinique Chinirg., vol. ii., p. 204. |f Bulletin de la Faculty, No. III. 



154 STERILITY — -CAUSES TREATMENT 

with cerate, so as to prevent the union of the flaps 
formed by this operation. In some cases, also, we 
have found the base of the vagina naturally obliterated 
by a more or less dense membrane, which presented 
the same obstacles to the flow of the menses and to 
coition. This circumstance can not be detected so 
easily as the preceding, and the operation is more 
doubtful and difficult, especially if the obliteration oc- 
cupies a certain extent in the vagina. Morgagni,* 
when consulted in regard to a case of this character, 
did not dare to advise the operation lest the bladder 
and rectum might be wounded. Nevertheless Prof. 
Flamant and Dubois recommended to prolong the 
opening by following the natural direction of the pas- 
sage ; but this operation, which may be attended with 
the most serious inconveniences, requires the applica- 
tion of the precept of Gardient to ascertain in ad- 
vance if the uterus exist, and to wait until the female 
experiences symptoms of retention of the menses; and 
finally to be careful that the vagina does not open into 
the bladder or rectum as may be the case. 

If the parietes of the vagina adhere completely, art 
should respect this aberration of nature, rather than 
imitate the course of the surgeon mentioned by De- 
haen, who penetrated into the bladder without finding 
the vagina. 

6. Deviations in the direction of the Vagina. — The 

* Epist. Anat. Med. 46. f Traits des Accouchemens. 



IN THE MALE AND FEMALE. 155 

opening of the vagina into the rectum has been but 
seldom noticed. It may occur congenitally or acci- 
dentally. The most remarkable case is that related by 
Louis, in a thesis. I have had occasion to present an 
observation on this subject to the society of practical 
medicine at Paris : that of a female, thirty years old, 
in whom the vagina opened into the rectum above the 
sphincter. The menstrual discharge occurred regu- 
larly, and sometimes the blood collected, and did not 
resume its course till the female went to stool, or took 
an enema. This female was married, and three years 
had elapsed without sexual congress. I examined her 
with great care, and in penetrating into the rectum, it 
was easy to find an oval fissure behind the prominence 
formed by the sphincter, and from two to three inches 
in extent. I introduced the index finger there, and in 
advancing, 1 detected the os tincoe very plainly, and 
hence concluded that the female could be impregnated. 
Some time after this, the husband acting in accord- 
ance with my instruction, the female became pregnant. 
Before her confinement, I employed means for dilating 
the parts, such as fatty JDodies, emollient fomentations, 
prepared sponges, and lastly, gum elastic cylinders ; 
and by moderate efforts, I obtained great dilatation of 
the anus and vagina ; and the latter had become large 
enough to allow the child to pass. At parturition, the 
child presented in the first position of the head : the 
rectum and vagina were freely lubricated with oil, and 
I made all the dilatation possible, both of the vagina 



156 STERILITY CAUSES TREATMENT 

and anus. The child passed with difficulty througli 
the lower strait of the pelvis. On coming to the open- 
ing of the vagina, it remained there for some time ; 
but with the aid of a blade of the forceps, I disen- 
gaged the head without apparent injury to the rectum. 
AH the efforts of the poor mother, with my aid, could 
not overcome the resistance of the fibres of the sphinc- 
ter, the opening of which, with all our assistance, could 
not attain the diameter necessary for the passage of 
the child. After waiting the time necessary for the 
use of emollient hip baths, it was decided, in consul- 
tation, and by the consent of her parents, to divide the 
sphincter. I then made a deep incision near the peri- 
noeal region, and the delivery terminated happily. 
The head of the child was large, and the infant was 
strong, and well-made. The edges of the wound were 
brought together with sticking plaster, and kept in 
place by an appropriate bandage. The succeeding 
dressings were made with the most minute precau- 
tions ; the parts suppurated ; the cicatrix was closed 
imperfectly ; nevertheless, one point of the suture 
contributed to its approximation or agglutination, and 
at the end of five months, this female could retain her 
feces. She has refused, however, since this time, to 
indulge in intercourse, as she dreads the result of a 
second labor. 

Spasm of tlie Vagina. — Sometimes the vagina is so 
irritable, that it contracts on the slightest contact, and 
does not admit the introduction of the penis, or ren- 



IN THE MALE AND FEMALE. 157 

ders its introduction difficult and painful to the male 
and female. If an examination of this passage be 
made with the finger, this examination is difficult and 
painful, and the mucous membrane is dry, arid, and 
not lubricated with mucus. This state of spasm and 
dryness is frequently a symptom of chronic affection 
of the uterus ; but sometimes it exists independent of 
any other complaint. In this latter case it is remedied 
by emollient and mucilaginous lotions and injections, 
and by introducing large tents smeared with a fatty 
body, and a pommade of simple cerate and extract of 
belladonna. 

Polypi* — The presence of polypi within the vagina 
may become a cause of sterility, by the difficulties 
thereby opposed to the exercise of coition, and by 
changing the direction of the penis and neck of the 
uterus. We shall see, when speaking of uterine 
polypi, the treatment then to be adopted for this 
symptom. 

Vaginal Fistulce. — The natural communications of 
the vagina with the rectum and bladder, some instan- 
ces of which are known — those more frequent which 
result from a laceration, or a gangrenous inflammation, 
after difficult labor, or any operation in which the in- 
strument might injure the vagina — constitute so many 
causes of sterility. Beside the disgust inspired by 
such an infirmity, it necessarily renders the coition 
unproductive, by changing the natural direction of the 
seminal fluid. In many cases of this kind, I have 

14 



158 STERILITY CAUSES TREATMENT — 

profited by the idea concurred in by Desault and 
Baudelocque, when treating of natural and accidental 
communications of the vagina with the rectum and 
bladder. I have had instruments made of gum elas- 
tic, modified in the speculum of Recamier, so as to be 
adapted to the state of parts. Among the examples 
of success obtained in this way, I will here mention 
three cases. 

Case 1. — The wife of a watchmaker in the prov- 
ince, experienced, in a difiicult labor, which had 
required embryotomy, a laceration of the recto-vaginal 
septum, which occupied a great part of the vagina. 
This accident was followed with sarcomatous V3geta- 
tions so large as to establish a kind of channel for the 
penis, and thus gave a mal-direction to the emission of 
the seminal fluid. To obviate this, I applied a semi- 
speculum of silver, which I constructed as the state of 
the parts required ; the end of which was designed to 
fix anteriorly the os tincoe, which had inclined back- 
ward, to compress the tumor, which opposed the intro- 
duction of the penis, and to destroy the relation of the 
vagina with the rectum. By the aid of this instru- 
ment, kept in place by several strips which were 
attached to a circle placed around the pelvis, this lady 
gave new proofs of fecundity. 

Case 2. — The wife of a restaurateur, at Paris, re- 
quested my advice on account of a natural communi- 
cation between the bladder and vagina. The opening 
was such that in coition, the penis entered the bladder. 



IN THE MALE AND FEMALE. 159 

After examining the parts, I thought proper to use the 
instrument mentioned in the preceding case, modifying 
itj however, so that it could be adapted to the pubic 
face of the vagina, vi^here the point of communication 
existed. The apparatus was applied as in the prece- 
ding case, and w^ith the same success. In a few days 
after the cessation of the menses, madame became 
pregnant, and was happily delivered. Only I was 
obliged with one blade of the forceps, to depress the 
head, w^hich at each contraction of the uterus tended 
to penetrate into the opening of the bladder. I ought 
here to remark, also, that this lady, refusing to submit 
to the introduction of this instrument again, had no 
more children. 

Case 3. — The subject of this case is the wife of 
Col. S., who, in a first labor, had the recto-vaginal 
septum completely torn. This accident, which seemed 
to arise from a very marked depression of the arch of 
the pubis, and which Dubois and Richerand had con- 
sidered incurable, rendered all conjugal approaches 
ineffectual, as the semen was discharged into the rec- 
tum, or out of the body. Being sent for by Madame 
S., who was anxious to have other children, I saw no 
mode of remedying the defect, but by using a specu- 
lum, the uterine extremity of which should depress the 
base of the vagina. This was followed by the desired 
success. 



160 STERILITY CAUSES TREATMENT — - 

^U. DISEASES OF THE ORGANS OF SECRETION. 

1. Absence of the Ovaries. — Although the existence 
of the ovaries is one of the conditions most necessary 
to generation, one of the two may be deficient, or its 
functions may be entirely lost, and this circumstance 
may not produce sterility. We find in William Hun- 
ter, a fact, which justifies this assertion completely. 
The natural or accidental absence of the two ovaries, 
necessarily produces sterility. 

2. Absence of the Spermatic Arteries. — Poupart has 
stated, in the Memoirs of the Academy of Sciences 
(1701, ob. 1, p. 35), the history of a young girl in 
whom the spermatic arteries and veins were deficient. 
We can conceive that this circumstance (but few cases 
of which are known), must, like the preceding, give 
rise to incurable sterility. 

3. Inflammation of the Ovaries. — Without mention- 
ing here, as a cause of sterility, the acute inflamma- 
tions of the ovaries, which attend those of the uterus 
and peritoneum^, and which necessarily indispose the 
patient for sexual functions, there are different other 
degrees of phlegmonous irritation, the progress of 
which is more slow and obscure, and which may, how- 
ever, produce sterility, without manifesting its exist- 
ence, except by general phenomena. Thus chronic 
inflammations of the ovaries, whether concomitant 
with, or consecutive to, those of the uterus, have ap- 
peared in many cases to oppose fecundation, either 
simply by the derangement of the functions of the ova- 



IN THE MALE AND FEMALE. 161 

lies, or by the narrowness or obliteration of the tubes 
which attend it. 

There is still one kind of temporary inflammation 
of the ovaries, to which few authors have paid atten- 
tion, because it is indicated generally only by nervous 
phenomena, but which seems to us to be the proximate 
cause of sterility in most females, endowed with the 
uterine temperament. We find in Bonnet,* Blegny,t 
Lieutaudjt and Blancard,|| different instances of swel- 
lings of the ovaries observed only after death, in fe- 
males affected with hysteria and nymphomania. 

The treatment of sterility arising from any inflam- 
mation of the ovaries, is naturally deduced from the 
theory of the disease. Thus, leeches to the two iliac 
regions, hip baths, emollient cataplasms, and enemata, 
combat with i\td same success, both the accidents of 
hysteria, and the sterility resulting from it. I might 
cite several cases of females who were sterile, or 
affected with nymphomania, who have regained their 
fecundity under this treatment. Sometimes, in these 
cases, after employing the remedies mentioned, I have 
made two issues, and kept up the suppuration for sev- 
eral months. 

Induration and Schirrous of the Ovaries. — Although 
these accidents most generally occur in females who 

* Sepulchr. Anat., sect. S. 

t Journal de Med., vol. xxi. 

X Hyrt. Anat. Med., part 1, obs. 1494. 

II Prax. Med., p. 175. 

14* 



162 STERILITY CAUSES TREATMENT- 



^ 



have passed the critical age, it is not unfrequent to find 
them in women possessing all the attributes of their 
sex, and especially, in those who have had several 
difficult labors. The schirrous state of the cvaries 
does not prevent fecundation, unless both these organs 
are affected at the same time, since it is almost proved 
that conception usually takes place only on one side. 
Instances have been cited, too, where females have 
become pregnant, although they have had tumors of 
different sizes in the region of the ovaries, a circum- 
stance which it is difficult to explain, except by the 
integrity of the vesicles coinciding with alterati m of 
the envelopes of the ovaries. 

We regard sterility from such a cause as absolutely 
incurable. It is certain, in fact, that if the employ- 
ment of means for treating phlegmonous irritation, 
which precedes it, has been unsuccessful, we can not 
hope to obtain complete resolution until the induration 
has arrived to a certain extent. The treatment in this 
case belongs to general pathology, and it would be 
useless for us to detail it here. 

5. Osseous and Calcareous change of the Ovaries. — 
These two modes of organic alteration, several instan- 
ces of which we know, and are observed even in 
young females, would necessarily imply sterility, if the 
two ovaries were simultaneously affected, of which 
Chopart states a remarkable instance. Although it is 
difficult to detect the existence of such causes during 
life, it is still less permitted to expect their cure. 



IN THE MALE AND FEMALE. 163 

6. Dropsy of the Ovaries. — Dropsy and hydatids 
of the ovaries being most generally only a complication 
of the schirrous degenescence of these organs, consti- 
tute causes of sterility, which commonly resist all treat- 
ment. (See Schirrous of the Ovaries.) 

7. Absence or Alteration of the Corpuscles of the 
Ovaries. — Malpighi thinks that the absence of the 
ova or corpuscles of the ovaries may be a cause of 
sterility. We know, also, that the ovaries may pre- 
sent a healthy appearance, although their internal or- 
ganization may be affected with serious lesions. Mor- 
gagni, and ValHsnieri, have admitted, as a cause of 
sterility, different alterations in the corpuscles of the 
ovaries, which they have observed after death in per- 
sons who have been sterile. But we must admit that 
the internal structure, and the functions of the ovaries, 
are still too little known, to give any opinion on this 
point. 

8. Hernias of the Ovaries. — The displacement of 
the ovaries, of which we find many instances in surgi- 
cal works, have been thought by many authors, to 
produce sterility. But as they frequently attend her- 
nias of the uterus, perhaps the sterility of females 
who present this structure, should be referred to the 
last cause. Pott (on Hernia) cites a case where the 
two ovaries were contained in the same sac, without 
giving rise to sterility. Portal, also, relates the case 
of a female who died in labor, and in whom the right 
ovary was found to have passed from the abdomen 



164 STERILITY CAUSES TREATMENT 

through the ischiatic notch. It may be that at the 
moment of the formation of the hernia, the ovaries 
inflame, and contract adhesions with the part, through 
which they pass, and thus lose their functions. 

The therapeutic indication of hernias of the ova- 
ries is founded solely on the mode and kind of dis- 
placement of these organs. It is important, however, 
to ascertain that this displacement does not occur at 
the same time as that of the uterus, so that the means 
of reduction may be applied directly to this organ. 
{See Deviations of the Uterus,) 

^III. DISEASES OF THE ORGANS OF CONSERVATION. 

1. — Absence of the litems, — Many authors, among 
others Columbus {De re Anatom., lib. 15), Baude- 
locque {Art des Accouchemens, vol. 1, p. 195), and 
Chaussier {Bull, de la Fac. de Med,), have mentioned 
instances of the absence of the uterus. This devia- 
tion of formation may exist alone, but is generally at- 
tended with absence of the vagina, and causes, in 
either case, positive sterility. It would not be the 
same were the uterus replaced by a simple membra- 
nous pouch, capable of supplying its functions to the 
end of labor. 

A young girl of Vienna, in Austria, aged twenty- 
four years, of common height and constitution, passed 
from the anus, every twenty or twenty-five days, a 
large quantity of blood, but presented no other phe- 
nomena of menstruation. She enjoyed perfect healthy 



IN THE MALE AND FEMALE. 165 

and performed the duties of nurse at the Lying-in 
Hospital at Vienna, for about six weeks, when she was 
attacked with pains in the groins and kidneys, which 
compelled her to keep her bed. Having examined 
her by touching, I found neither neck nor orifice of 
the uterus. On raising the tumor, which projected a 
little into the cavity of the pelvis, I felt, at several dif- 
ferent times, very distinct motions, which led me to 
suspect pregnancy. From this time to the end ges- 
tation, the patient was obliged to keep her bed. Re- 
peated bleedings, hip-baths, and emollient enemata, 
produced but slight improvement. The nearer she 
approached the end of pregnancy, the more she suf- 
fered. About the ninth month, we detected in every 
direction in the cavity of the pelvis, the child's head, 
through an extremely thin membrane of a dense tex- 
ture ; on the right, and a little backward, was found a 
round opening, about two lines in diameter. Seeing 
that the strength of this unfortunate female was daily 
declining, and that she was in the last stage of maras- 
mus, I determined to bring on labor. In this, I was 
assisted by Drs. Prussielgue, Richard, Meunier, and 
Schult, who were all of my opinion. With this 
view, having placed the female in a proper position, 
we made at the lowest part of the organ, an incision 
large enough to permit the extraction of the child ; 
the amniotic fluid was discharged, the head presented in 
the second position, and the labor was readily termi- 
nated by the forceps. The child, a male, was feeble, 



166 STERILITY CAUSES TREATMENT 

although apparently full grown, and it lived for several 
hours. The umbilical cord was very thin, about seven 
and a half inches long, and without a placenta ; it was 
attached on the right side of the vertebral column, 
nearly at the base of the kidney. All my efforts to 
detach it were useless, and it suppurated off on the 
fifth day. The female died from inflammation, which 
could not be arrested. On opening the cadaver, we 
found in the place of the uterus, a very compact mem- 
branous pouch, which adhered intimately to the lower 
part of the vertebral column, and with some portions 
of the mesentery, epiploon, and even the ascending 
colon. This membrane received two principal arte- 
ries, the size of a pigeon quill — the right arose from 
the renal, the left from the hypogastric of the same 
side. It was supplied with very many nervous fila- 
ments, coming from the great sympathetic nerve. 
There was but one ovary and tube, which were changed 
by inflammation. The other parts of the abdomen 
presented nothing remarkable. 

2. Closing of the NecJc, Body, and Orifice of the 
Uterus. — The neck of the uterus may be closed natu- 
rally by a membrane, or be obliterated by inflam.mation 
or schirrous tumors developed in that part. This clo- 
sing may be perfect or imperfect : in the former case, 
conception is impossible ; in the second case, when 
the menstrual discharge is seen, fecundity may occur 
in some cases, but is not always possible. We know 
that at the moment the seminal fluid is projected upon 



IN THE MALE AND FEMALE. 167 

the orifice of the neck of the uterus, this neck per- 
forms a movement of suction which is peculiar to it, 
and seizes the semen : it may escape when this action 
is imperfect. 

Ahhough it is not always easy to detect the different 
kinds of alteration and to proceed to their cure, yet if 
touching reveals a foreign body in the orifice of the 
uterus its removal should be attempted. A simple 
membrane v/ill be readily divided by a common trocar, 
a strdght bistoury, and perhaps still better, by a trocar 
and canula. I prefer the latter, the course of which is 
more certain. Chaussier has known this closing sev- 
eral times to be the effect of a membranous concretion 
of a coagulable character. Boyer, in his treatise on 
surgical diseases, relates several cases of this, among 
others, two of Littre and Benevoli are very curious. 

Uterine polypi are not rare, and are easily detected, 
especially those which arise from the neck. They are 
at first very small, and imperceptibly acquire greater 
development. Unhappily, most females who are af- 
fected with these excrescences, are informed of them 
only by the severe pains they feel in the kidneys, groins, 
and thighs, or by the irregularity of the menses ; and 
besidg, from feelings of modesty, they are unwilling to 
be examined till the last moment. The removal of 
the polypus is the only mode of cure. The practi- 
tione* will select the mode of operation, having prepa- 
red for it by proper treatment. On this point I shall 
relate two cases. 



168 STERILITY CAUSES TREATMENT 

Mad. L. married a second time, about two years 
since ; being still young, and generally in good health, 
she was very anxious to have a family, having had no 
children by her previous husband, when she began to 
feel symptoms which indicated the commencement of 
pregnancy. The physician at Orleans, who was con- 
sulted, took the same view of the case, but the deep- 
seated pains in the lumbar region soon gave rise to the 
suspicion of some unknown complaint ; I was sent for, 
and soon found a polypus in the neck of the uterus 
projecting into the vagina. After proper treatment I 
applied a ligature to this polypus but not without some 
difficulty. On the fifth day I divided the peduncle 
with the bistoury, and took away a pear-shaped livid 
polypus weighing six ounces. This lady soon recov- 
ered. Three months afterward she had symptoms of 
conception, which she regarded as a new polypus, and 
it was not till the fifth month of pregnancy, that she 
was undeceived by feeling very distinctly the motions 
of the fetus. 

The second case is that of a female who had borne 
several children, and when thirty-seven years old was 
affected with symptoms which she regarded as a new 
pregnancy : her sufferings increased daily. There 
was a consultation held of three physicians, I being 
one, to ascertain and examine the disease of this lady. 
On examination per vaginam, I detected a polypus in 
ihe neck of the uterus, and this w^as verified by the 
speculum. One month afterward, this time being re- 



fii 



IN THE MALE AND FEMALE. 169 

quisite to prepare for the operation, I removed the tu- 
mor by the same process and in the same manner as 
in the preceding case. Pregnancy occurred eight 
months after the operation. The same means are 
used for the removal of polypi from the body of the 
uterus. 

3. Circa-Uterine Membrane. — Having attended, for 
a long time, specially to the study of the causes of 
sterihty, and the means of treating it, I have found 
this membrane in two cases of females who died ster- 
ile, and had never menstruated. This membrane was 
united with the tissue of the uterine mucous mem- 
brane near the base of the neck of the uterus, and it 
was impossible to divide them. But it was easy, with 
a scalpel, to remove it from the whole surface, except 
where prolongations went from it into the tubes. This 
membrane had the form of a bursa ; its mucous tissue 
was slightly dense and compact, and resisted the cut- 
ting instrument. Its color was of a grayish white, its 
thickness was about a line : it adhered in both cases 
to the Fallopian tubes, which were closed hermetically. 

I have had occasion to see fragments of the same 
membrane obliterating the passage, in the amphitheatre 
of Dr. Laurens, at Paris, a gentleman distinguished 
for his erudition in anatomy and physiology. Some 
English practitioners have also observed the same 
membrane, and it has been noticed by Dr. Clemens, 
of Frankfort on the Maine, in the uterus of a sterile 
female. Professor Norfini, of Florence, has shown 
15 



170 STERILITY — CAUSES — TREATMENT — 

me this membrane, preserved as a wet preparation, in 
the cabinet of the Facuhy of Medicine, of that city, 
a cabinet which possesses a very curious collection of 
pathological specimens. It will be seen that, in these 
cases, art fails. 

Many authors have recommended hysterotomy in 
cases Vv^here the uterus is completely obliterated, which 
induced me to open the neck of the uterus, in two 
females where the neck was long, and then, while the 
body was very small ; and these two cases are recorded 
in the succeeding article — Atrophy of the litems. 
This operation is demanded by the pathological or ab- 
normal adhesions, and, also, the schirrous induration, 
which obliterate the neck of the uterus, in females 
enjoying, in other respects, the attributes of their sex. 
And this is done, not only to re-establish the relations 
between the vagina and the uterus, but also to arrest 
the progress of organic changes, which might endan- 
ger their existence. With this view, Dupuytren has 
performed this operation several times, on subjects af- 
fected with these diseases. 

4. Want of a Cavity and Atrophy of the Uterus. — 
The uterus may exist without any uterine cavity, or be 
wasted so much as to nullify its functions. Levret 
and Smellie have cited several instances of this. Hal- 
ler {Disputat. Anatom.), Baudelocque, Flamand, and 
Desormeaux, have opened females in whom the uterus 
was excessively small ; though this does not prevent 
intercourse, there is always sterility. I stated the fol- 



IN THE MALE AND FEMALE. 171 

lowing cases, in 1834, to the Society of Practical Med- 
icine, at Paris. 

Madame V., an English lady, twenty-three years 
old, of lymphatic constitution, and moderate in &esh, 
had enjoyed perfect health until nearly sixteen years 
old, when the marks of puberty began to appear ; but 
there was no menstrual secretion. She was very much 
affected by this, and the physiological phenomena were 
obstructed. A violent peritonitis soon followed, for 
which she took mercury in large doses, while her ab- 
domen was rubbed freely with mercurial ointment, 
once or twice, daily. This heroic treatment aggra- 
vated the disease ; but, by the use of antiphlogistics, 
she was cured. The physical form of this lady be- 
came more developed, until the age of twenty, without 
any appearance of menstrual discharge. At this time, 
she married a vigorous young man ; and, by sexual con- 
gress, the genital system was rendered very active, so 
that about every six weeks, this female perceived, for 
forty or fifty hours, a w^eight iT)out the uterus, with 
heat, as at the appearance of the menses, and, after 
sexual congress, there was great irritation in the vulvo- 
vaginal canal. The sexual relations were suspended, 
baths, hip-baths, injections, and lotions of emollient 
substances, quieted all these symptoms, which re- 
appeared for several times, but wiich were finally re- 
moved. The desire of a family induced them to seek 
professional advice. They applied to Sir Astley 
Cooper, who recommended the opening of the neck 



172 STERILITY CAUSES TREATMENT 

of the uterus as the only mode of giving issue to the 
menses, and the facuhy of conceiving. This propo- 
sition was rejected. In 1835, N. brought bis wife to 
see me, and, by touching and the speculum, I detected 
a uterus, which was very small ; it was a little longer 
than natural, and was soft, and thrown backward, 
probably by the penis in the act of coition. It had 
no opening, and seemed to form a compact whole. 
My views, as to the plan of treatment, coincided with 
those of Sir Astley. Prof. Dubois also agreed in this 
opinion, while Baron Boyer rejected it as dangerous 
and rash. Finally, the desire of having a family con- 
quered her repugnance, and this lady determined to 
follow my counsels. A course of hygienic treatment 
was adopted, and I then proceeded in the following 
manner : all the dorsal, lumbar, and iliac surfaces, as 
also the inner parts of the lower limbs, were rubbed 
with special embrocations, and warm baths, hip-baths, 
and thermal douches, were also employed, as well as 
malaxating, shampooing, while, w^ith a congester, I 
kept up a constant action on the uterus. I gradually 
succeeded in rendering this organ hypertrophied, so 
as to make it very perceptible to the sight and touch. 
All the tissues which seemed inanimate before this 
medication, soon assumed a vigorous aspect. I was 
obliged, not only to permit this interesting patient to 
rest, but, also, to have recourse to antlphloglstics ; and 
to the repeated application of leeches to the upper 
part of the thighs, the vulva, uterus, and to a slight 



IN THE MALE AND FEMALE. 173 

revulsive bleeding from the arm, in order to diminish 
the sanguineous congestion of the genital organs. 

Finally, it was decided that the uterus was favorably- 
disposed for opening its neck. A day and hour were 
therefore appointed, and in the presence of our pre- 
ceptor, the venerable Dubois, and other assistants, I 
operated (July 5, 1833) in the following mode : The 
patient was placed in the usual manner — laid horizon- 
tally on a kitchen table, covered with a mattress, the 
head a little elevated, the pelvis fixed so that the ischi- 
atic tuberosities were on a level with the edge of the 
bed. The legs and thighs were flexed, and separated. 
A broad band was passed around the loins, provided 
with a large pad, by which an assistant pressed the 
abdomen so as to push down the uterus. 

A bivalve speculum, as seen in the cut, lightly 

[Fig. 24.] 




smeared with lard, was introduced into the vagina. 
This form of speculum has the advantage of embracing 
the base of the neck, and of removing the folds which 
may form around the neck of the uterus. The low- 
er two-thirds of the neck of the uterus was then 
grasped by the congester, so as to bring it as near as 
15* 



174 STERILITY — CAUSES — TREATMENT 

possible to the vulva. This done, a thick riband, sev- 
eral lines broad, was placed at the base of the neck, 
at that part which was left free. The congester was 
withdrawn, and I then introduced a semi-metrastere 
on the lower face of the speculum, to keep the neck 
and the portenoeud firm and quiet, the whole being 
held by an assistant. I divided the summit of the 
neck with an abscess lancet, and then introduced a 
uretrotome, armed v/ith a very sharp blade, between 
the edges of the incision, pushing the instrument as 
gently and carefully as possible, to make a straight 
passage, and directed it with two fingers of the left 
hand, keeping the neck on the metrastere ; after some 
resistance, I passed through the neck and penetrated 
into the cavity of the uterus, without wounding it. 
The portenoeud and the riband were removed, and 
when the blade of the uretrotome was withdrawn, a 
little bloody serum escaped through the canula : the 
hemorrhage was slight; some emollient injections, 
which were almost cold, were introduced into the 
uterus, to cleanse it. No serious symptom super- 
vened. 

The patient was put upon a diet, and the use of di- 
luent drinks ; injections of mild substances v/ere made 
several times daily into the vagina as well as into 
the cavity of the uterus. The next day, the pulse 
being quicker, a revulsive bleeding was made from the 
arm, and the symptoms subsided. The pains, which 
in their period of increase radiated from the centre of 



IN THE MALE AND FEMALE. 175 

the Uterus to the internal parts of the genital apparatus, 
to the kidneys and stomach, from which mucous and 
bilious matters were vomited several times, gradually 
subsided. Suppuration supervened in the neck with- 
out any peculiar phenomena, and was favored by as 
much attention to cleanliness as possible. On the sev- 
enteenth day, I withdrew the canula which was repla- 
ced by a hollow sound of larger calibre, and every day 
I introduced into the uterus mild injections, as infu- 
sions of lettuce, &c. The sound was changed several 
times, every time a larger one being inserted, and was 
finally withdrawn when the patient, in the opinion of 
Dubois, was perfectly cured. 

About a month after the recovery of this lady she 
indulged in coition, which soon caused a new determi- 
nation to the uterus, new pains, and a discharge of 
blood followed for the first time : this slight menstrua- 
tion continued only for thirty hours. Some days after 
the discharge,! was obliged to take some blood from 
the arm, which, with two warm baths, relieved the ir- 
ritation in the vulvo-vaginal canal. The conjugal du- 
ties w^ere again performed at intervals so as to avoid 
vaginal irritation. Menstruation again occurred, and 
more freely than the first ; and after this symptoms of 
pregnancy soon appeared, and in due time the lady 
was delivered of a daughter. 

Another remarkable practical fact of the same char- 
acter presented itself at the beginning of the next 
year. A provincial lady, of a good constitution and 



176 STERILITY CAUSES TREATMENT— 

lofty Stature, had nevertheless reached the age of 
twenty-two years without having menstruated : for 
more than four years she experienced at each return 
of the menstrual period a feeling of weight and burn- 
ing towards the iliac region and deep parts of the gen- 
ital apparatus, always without any appearance of the 
menstrual discharge, then giddiness and suffocation 
supervened, which obliged her to lose some blood. 

This lady being married, the copulative functions 
soon caused determination of blood to the genital sys- 
tem : about the menstrual period she felt severe pains 
in the pelvis, and a good deal of tenesmus ; and it 
seemed to her as if she wanted to pass something from 
the vagina. This state continued, but as she lived in 
the country she was tardy in applying for medical at- 
tendance, and a physician did not see her till she be- 
came affected with metroperitonitis, which was hap- 
pily treated by antiphlogistics. Six weeks afterward, 
when she imagined herself slightly recovered, she felt 
a painful spot below the two false ribs on the left side, 
which became very intense ; a tumor soon appeared in 
this spot, gradually enlarged, and fluctuation was de- 
tected. In this state the female came to Paris, to con- 
sult Prof. Roux. He opened the tumor, which dis- 
charged a large quantity of pus of a nauseous odor. 
The tumor did not disappear till after suppuration had 
continued for two months and a half. This female re- 
turned home : sexual relations and another menstrual 
period brought on the symptoms already mentioned, 



m i 



IN THE MALE AND FEMALE. 177 

and revulsive bleedings, diluent drinks, hip-baths, and 
clysters were used. In a journey I made to Orleans 
to see a lady affected with a polypus in the uterus, this 
lady told me the preceding facts, which were con- 
firmed by her physician, and I ascertained by touch- 
ing, and by investigations through the vagina and rec- 
tum, and by the uterine speculum, that although the 
neck of the womb was in the normal state, it had no 
opening. The uterus was very much developed : I 
indicated immediately the sole treatment to pursue, 
which was rejected with disgust. Eight or ten months 
afterward, annoyed at the trouble attending each men- 
strual period, this lady came to find me, to submit to 
the operation I proposed, which was performed in the 
same manner, and with the same success as in the pre- 
ceding case. Severe regimen was followed for three 
months, after which the menses appeared, and there 
was no return of the trouble. Her health now im- 
proved, and in a short time she mentioned to me that 
she was pregnant. 

5. Leucorrhoea, — Hippocrates [De aere^ aquis, et lo- 
cis,) thought that leucorrhoea would oppose fecundation. 
If this opinion, which has been adopted by many au- 
thors, presents numerous exceptions, we can not deny 
that sterility is frequently seen in persons affected with 
leucorrhoeal discharge ; and I could cite several cases 
of females who have not become pregnant till after the 
cessation of this discharge. Chronic leucorrhoeas 
seem particularly to give rise to steriHty, possibly by 



178 STERILITY CAUSES TREATMENT 

the obliteration of the tubes which sometimes causes 
it. 

While leucorrhcea may of itself become a cause of 
sterility, it deranges the health of the individual more 
or less, and therefore deserves in this double respect 
all the attention of the physician. 

It does not fall within our province to mention here 
all the remedies which have hitherto been proposed for 
this kind of affection, but we will state that the reme- 
dies from which we have obtained most success in these 
chronic discharges are the employment of cutaneous re- 
vulsives, such as the use of the baths and douches of 
Bareges, dry frictions over the whole body, added to 
the use of woollen or flannel shirts. In cases where 
the disease is obstinate, we have used flying blisters and 
even issues about the lumbar region when the disease 
is obstinate. 

There are also cases where tonic and ferruginous 
preparations may be of some use as Haller observes, 
but they must be administered with care. 

6. Amenorrhcea. — As impregnation requires the 
physiological integrity of the organs of generation, 
amenorrhoea will be found one of its principal obsta- 
cles. The derangement of the vital properties of the 
uterus, which necessarily attends suppression of the 
menses, most generally renders this organ incapable of 
being impregnated. But perhaps we must distinguish 
the fact of the suppression from the physiological mod- 
ifications produced in the uterine system, inasmuch as 



IN THE MALE AND FEMALE. 179 

this latter circumstance alone seems to us to constitute 
the cause of sterility. In fact, females conceive who 
do not menstruate, which has led some authors to say, 
and with reason, that menstruation is not indispensable 
to conception. I know a lady who is the mother of 
three children, and who has never menstruated. In 
the course of the year she never loses more than an 
ounce or two of blood, at two or three different pe- 
riods : her health is good, but we can see it would not 
be so if the defect or irregularity in the menstruation 
were attended with habitual trouble in the vital proper- 
ties of the uterus, and in the health of the individual. 
It is in this latter case, that amenorrhoea usually brings 
on sterility, which proves also, that menstruation is ra- 
ther the effect than the cause of puberty, and that the 
female is not sterile because she is not regular, but be- 
cause the uterus does not possess the degree of action 
necessary to fecundation. 

It is difficult to estabhsh general rules of treatment 
for a disease which demands as many remedies as 
there are causes of it : the remedies also will vary ac- 
cording as the suppression is sudden or slow, according 
to the constitution of the individual, and the occasional 
causes of the disease. We must consequently de- 
pend but little on the action of the remedies called 
emmenagogues, at least, unless special indications 
exist which is very rarely the case, and even in this in- 
stance it is perhaps more prudent to have recourse to 
slightly stimulant anti-spasmodics, such as distilled aro- 



180 STERILITY CAUSES TREATMENT 

matic waters, added to ether, acetate of ammonia, &c. 
RoyerCollard also has mentioned electricity as a pow- 
erful emmenagogue ; but this remedy must be used 
with prudence, if the uterus be the seat of a sanguin- 
eous congestion or nervous irritation which must first 
be relieved. 

7. Me?i07'rhagia. — This disease, like the preceding, 
may impede impregnation, as it modifies, analogously, 
the uterine system, although it presents very opposite 
characters. In fact, in the first case, menstruation 
ceases, because the uterus has not the degree of sen- 
sibility necessary to call to itself the materials of this 
function, or, because it becomes accidentally a focus 
of irritation and congestion, which suspends its secre- 
tory action. In menorrhagia, this organ, which is in- 
ert, or endowed with a kind of vital exaltation, w^hich 
is followed by a more or less free sanguineous exha- 
lation, seems to be placed under the same physiologi- 
cal conditions. 

Need I say, that the treatment of menorrhagia, like 
that of the preceding disease, must be varied accord- 
ing to the numerous causes which produce it, and 
that here, as in all rational therapeutics, we must try 
to bring the diseased organ under the influence of 
remedies capable of imparting to it the type of sensi- 
bility, necessary to the exercise of its functions. It is 
to the rules of hygiene that the physician will resort 
for the surest modes of regulating menstruation. The 
horizontal posture, rest of body and mind, food not 



IN THE MALE AND FEMALE. 181 

very substantial, slightly acid, and easily digestible ; 
in the periods between the menstrual discharge, mod- 
erate exercise in the country, agreeable amusements, 
hip-baths, enemeta, and injections of cold water, &c., 
— these are the most powerful means of moderating a 
too abundant periodical discharge. 

8. Hysteria, Nymphomania, Erotomania, &c. — The 
exaltation of the vital properties of the uterine system, 
which has received as many names as it assumes 
forms, seems to us to embrace here the different affec- 
tions designated by authors under the terms hysteria, 
nymphomania, &c. In fact, whether we consider 
these different anomalies as causes or effects of the 
venereal excitement which constantly attends them, 
we must admit that their general or local phenomena 
arise from the same source — that is, from some lesion 
of the genital system ; and that to this latter circum- 
stance, must be attributed the sterility with which 
many hysterical or nymphomaniac people are affected. 
This truth finds irresistible witnesses in the observation 
of the anatomico-pathological facts which attend, in 
most cases, the commencement of the disorder. Thus 
Diemerbrock and Morgagni have found some altera- 
tions in the genital organs, on examining the bodies 
of hysterical females. It is sufficient, also, to admit 
the constant state of spasm of the uterus, in females 
affected with this disease, to account for the perversion 
of the genital functions. These different circumstan- 
ces, however, rarely oppose fecundation, inasmuch as 

16 



182 STERILITY CAUSES TREATMENT 

they generally occur in those persons who live in a 
state of celibacy, or widowhood. Sometimes, how- 
ever, they are seen in married females, in consequence 
of the frequent repetition of the sexual act, ex fre- 
quente coitu. In some cases, also, they occur under 
the influence of clitorism, of which we have already 
mentioned remarkable cases. 

Our opinion as to the theory of neuroses or gen- 
eral anomalies, which do not differ here except in 
their general phenomena, and in the moral circumstan- 
ces which attend them, necessarily dictates, in regard 
to each of them, the same mode of treatment, modi- 
fied, however, by the nature of the symptoms. Gen- 
eral or local bleeding, baths at a low temperature, 
dashes of cold water on the kidneys, exercise, travel- 
ling, &c. ; and all the remedies capable of distracting 
the mind, have often favored the impregnation of peo- 
ple affected with this kind of symptoms, by subduing 
passions too ardent, or too much excited by abusive 
enjoyments. 

9. Anaphrodisia, — Pleasure, says Magendie, enters 
as an element into the act by which the human spe- 
cies is perpetuated ; and although females have been 
impregnated, when indifference or hatred were promi- 
nent in unions disavowed by the heart, it is certain that 
pleasurable delight is the circumstance most favorable 
to conception. Many females are sterile, only because 
they co-operate coldly and passively in their conjugal 
duties ; while the female who tastes the sweet delights 



IN THE MALE AND FEMALE. 1S3 

of pleasure has already a presentiment that she will 
be a mother. The reason that prostitutes conceive so 
rarely, is because their genital organs pass from a state 
of venereal excitement to true anaphrodisia. The 
uterus, constantly stimulated by new acts, as Astruc 
remarks, soon loses its sensibiHty, and is then incapa- 
ble of being impregnated. 

As there are seasons which dispose to love, so, too, 
certain climates exercise a very marked influence on 
fecundity. Sterile females, inhabiting a cold or tem- 
perate climate, have become productive, when dwel- 
ling under a meridional sun, and vice versa. It has also 
been remarked that phlegmatic and very fat females 
conceive more easily in summer and in spring; while 
those who are ardent, or of a nervous temperament, 
require, as it were, to be tempered by winter, or a 
cold climate (Stein's De Causis Sterilitatis, p. 58). 
Other hygienic circumstances may also have a seda- 
tive influence on the genital system. 

Although abstinence can not be considered a direct 
cause of sterility, it may, moreover, throw all the or- 
ganic systems into a kind of inertia, and justify the 
adage — Sijie Cerere et Baccho friget Venus. Hip- 
pocrates, also, thought that hard and cold water ren- 
dered many females sterile, but this opinion is not 
confirmed in our day. This is not true of alcoholic 
liquors, the abuse of which seems to be more or less 
contrary to the reproductive process. Alberti has 
proved this in a thesis, entitled De Ebrietate Feminarum 



184 STERILITY CAUSES TREATMENT 

— that there are more females than males sterile from 
the effect of sphituous liquors. 

Anaphrodisia may also be the result of a defect in 
the relation and equilibrium between the physical and 
moral constitution, for although the female may be 
more independent of moral causes than the male, yet 
we may remark that most of those addicted to the 
study of sciences are sterile. In speaking of anaphro- 
disia in man, we have already mentioned the physio- 
logical reason of^ such an influence, in consequence of 
the unequal division of the vital powers, which are then 
devoted to mental processes — which led Roussel to 
rem^ark that a female, deeply occupied in mental pur- 
suits, existed only so far as the head was concerned. 

The female, also, is more free than the male from 
the moral causes which quiet the genital power. Nev- 
ertheless, the two following instances will prove that 
sterility may occur under the influence of this cause 
alone. A lady, who had an inclination for another 
person, previous to her marriage, sufiered the ap- 
proaches of her husband simply through a feeling of 
duty, and without any sensation of pleasure. After 
being married for several years, and without issue, she 
met at a ball, and in the dance, her former lover, who, 
she thought, had forgotten her ; but she experienced, 
on seeing him, such a lively emotion, that she was 
forced to leave the ball-room. The same trouble con- 
tinued all night ; and, for the first time, she experi- 
enced delight from the caresses of her husband. 



IlSr THE MALE AND FEMALE. 185 

The female who is the subject of the last case, en- 
joyed, at Paris, all the pleasures which an ample for- 
tune could afford, but she became wearied of them ; 
and remembered that she had been married nearly 
seven years without thinking of maternal happiness. 
By my advice, she abandoned the giddy whirl of the 
w^orld, and the gay pursuits of fashion, and retired to 
the country, where she was placed upon a course of 
treatment and regimen. After remaining there several 
months, one beautiful summer's eve, this lady was sit- 
ting near her husband, in one of those enchanting spots 
which are seen only in nature ; a river flowed with a 
gentle murmur at their feet ; the tufted trees extended 
their shadows even on the surface of the water : the 
sun was almost set ; and the stillness of evening was 
disturbed only by the fluttering and the song of birds. 
The softness of the air, the charm of the place, caused 
a gentle agitation in the mind of this lady, and at that 
moment, she felt a desire for her husband that she 
had never known before. She now soon became a 
mother. ' 

Other physical and moral causes which we have 
mentioned at length and more in detail, when speaking 
of anaphrodisia in the male, may also enfeeble, or even 
extinguish in the female, the reproductive power ; but 
we must admit that such effects are observed less 
frequently in one sex, which, to crown the work of 
generation, needs only to yield to the other sex. 
16* 



186 STERILITY — CAUSES — TREATMENT 

We must, however, remark, that if, under certain 
circumstances, the female is entirely destitute of vo- 
luptuous sensations, yielding only through condescen- 
sion to conjugal duties, this cause also may prevent 
fecundation, although it is not absolute. Many cases 
of this kind of anaphrodisia have been seen in my 
practice. It was so marked, that the ladies affected 
with it felt no change, and no sensibility, in the act of 
coition. 

I have known three ladies destitute entirely of a 
clitoris, who informed me they never felt any of the 
sensations they ought to experience, in coition. 

Be this as it may, we must direct our remedies to 
the genital system, and use the same therapeutic 
means as those we have stated for anaphrodisia, in the 
male. The treatment, however, will be modified ac- 
cording to the causes of anaphrodisia. We must keep 
up a more or less intense action on the external, or 
deep-seated genital organs, and must employ, in turn, 
the rubefacients, shampooing, and the congester. As 
shampooing can only be performed imperfectly with 
the fingers, we should, for the deep-seated parts, use 
forceps, made for this purpose. The congester will 
solicit a direct action on the uterus, especially on its 
neck. 

We must then use injections introduced thi'ough 
uterine sounds, as seen in the cut, and composed of 
thin flaxseed tea, oil of poppies, or of almonds, at 
a moderate temperature. The liquids must grad- 



IN THE MALE AND FEMALE. 

[Fig. 25.] 



187 




ually and successively be rendered more active, 
according to the sensibility of the patient ; and some- 
times it will be necessary to produce sensations so 
violent that the patient swoons. We must not neg- 
lect stimulating frictions, shampooing, douches on the 



188 STERILITY — CAUSES TREATMENT 

surfaces of the occipital, dorsal, lumbar, and glutoeal 
prominences ; and must also stimulate the muscles of 
the perineum and sphincter, as we have stated, when 
speaking of shampooing. 

9. Fibrous^ Cartilaginous j and Osseous Tumors of 
the Uterus. — Organic productions may be developed 
in the cavity or texture of the uterus, which vary in 
density, from the fibrous to the osseous state, and 
which have appeared in some cases to impede fecun- 
dation, either by closing the orifice of the uterus, or 
by changing the mode of vitality with which this organ 
should be endowed, to fulfil the work of generation. 
But art knows no mode of curing or detecting these 
different alterations during life. 

10. Schirrous and Cancer. — The almost constant 
obliteration of the orifice of the uterus, added to the 
excessive sensibility which usually attends schirrous 
alteration of its neck, will account for the sterility 
seen in most females affected with this disease. Ul- 
cerated cancer, also, may oppose conception, simply 
by the fact of obliteration ; but the more or less ex- 
tensive alteration which attacks the body of the ute- 
rus, must also render it improper for elaborating the 
seminal fluMj 'and for supplying the embryo with the 
materials necessary for its nutrition. Some facts, how- 
ever, seem to prove that a female may conceive, and 
carry a child the full term, notwithstanding the can- 
cerous alteration of schirrous of the uterus. This, at 
least, was the opinion of Levret, and also of M. Bayle, 



IN THE MALE AND FEIVIALE. 189 

and CayoL These latter, to justify their assertion, 
state the following case : — 

A female, eight months and a half pregnant, came 
to La Charite Hospital, Sept. 1, 1811, with excessive 
hemorrhage, which commenced on the previous De- 
cember — that is, at the period of conception. Be- 
tween the hemorrhages, there was an ichorous, fetid, 
and very abundant discharge ; and we found, on 
touching, that the neck of the uterus was entirely de- 
stroyed, and replaced by an uneven surface, in which 
it was impossible to distinguish the orifice of the ute- 
rus. Sept. 22, the female was delivered of a dead 
child, but well-formed, and full-grown. The same 
symptoms, however, continued, the strength failed, and 
the patient died on the twenty-fifth of February. 
The opening of the cadaver discovered a large ulcer, 
which had destroyed not only the neck of the uterus, 
but also the upper part of the vagina, which commu- 
nicated with the internal part of the urinary bladder 
by an opening about an inch in diameter. The whole 
surface of the ulcer was covered with a layer of pu- 
trid ulceration. On removing this material, the ero- 
sion of the uterus and vagina was seen extending two 
or three lines in depth ; but, beyond that, the tissue 
of the uterus appeared in its natural state. The body 
of the uterus had only its natural size, and all the other 
viscera were in a healthy state. 

"Without denying the possibility of fecundation in 
females affected with schirrous, or cancer of the neck 



190 STERILITY CAUSES — TREATMENT 

of the Uterus, we can not conclude, with the observers 
of this fact, that a female may also conceive and carry 
a child the full term, notwithstanding the deep erosion 
of the neck of the uterus by a cancerous ulcer ; for 
here, no symptoms of disease had preceded the mo- 
ment of conception. All the symptoms dated from 
this latter period, and seemed to arise, or, at least, to 
become more intense, as pregnancy advanced. Be 
this as it may, if the cancer does not prevent aptitude 
for pregnancy, it endangers the existence of the female 
and that of its fruit. Art, then, must attack it at the 
outset ; and, especially, before it has reached the body 
of the uterus, because it is then incurable. 

11. Hysterotomy^ or Extirpati07i of the Neck of the 
Uterus. — Hysterotomy, or extirpation of the neck of 
the uterus, seems to us to be the only mode of arrest- 
ing the progress of the disease mentioned, and of giv- 
ing some hope for a family. Osiander of Goettingen, 
Dupuytren, and Lisfranc, have performed this opera- 
tion many times, by different processes, and with unex- 
pected results, which have been followed by great suc- 
cess. Dupuytren used a speculum uteri with two or 
three blades, the forceps of Museux, with which he 
seized and brought down the neck of the uterus, and 
then with a catlin, or long and strong scissors, with 
flat curved blades removed the neck. Lisfranc pre- 
ferred two probe-pointed bistouries, one straight, and 
one with a curved blade. The forceps of Museux 
which he uses are longer and stronger, and the hooks 



IlSr THE MALE AND FEMALE. 191 

are less curved than those generally employed. A bi- 
valve speculum, bistouries of different sizes, and strong- 
curved scissors, complete the principal parts of the ap- 
paratus. 

The skilful physician of La Pitie read a memoir on 
the amputation of the neck of the uterus to the Acad- 
emy of Sciences, June 2, 1814, in v^hich he made the 
following remarks : — 

*' The following is a physiological fact of the high- 
est importance : the amputation of the neck of the 
uterus has proved that this part of the organ is not ne- 
cessaiy to pregnancy, and even when the neck of the 
uterus has been removed, gestation sometimes pro- 
ceeds favorably to its full term. Labor then generally 
terminates very easily. Of ten of those operated on 
by me, only one miscarried, at four months : she had 
committed imprudencies, which, under any other cir- 
cumstances, would have caused abortion. I would 
add that Mad. Carpentier, who has allowed me to use 
her rame, has borne two children at the full time, born 
in good health. Drs. Avenel and Bouclu attended 
her. I must not conclude this paper," says Lisfranc, 
"without stating to the Academy, that of the ninety- 
eight females operated on by me, eighty-four were 
cured, and fifteen died. Among the latter were seve- 
ral cases of relapses. We should remark, too, that 
our I'everses have only affected those in whom the 
disease had advanced very far: we hope then that 
as our new views on diseases of the uterus are more 



192 STERILITY CAUSES TREATMENT 

advanced, the chances of failure will be less as the 
operation will be performed sooner." 

Many cases mentioned in the Bulletin of the Fac- 
ulty of Medicine in Paris, favor this operation, which 
has restored to life and health many females attacked 
with engorgements of bad character, and cancers of the 
neck of the womb. The following case proves also 
that the same operation may remove sterility produced 
by another affection which would have required this 
remedy. Mad. N. had enjoyed perfect health until the 
age of fifteen years, when menstruation first appeared. 
Violent pains in the pelvic region, added to more or 
less intense nervous phenomena, and repeated at each 
return of the menses, often required the employment 
of bleedings, baths, and other soothing remedies. 
When twenty years old. Mad. N. married ; but this 
only rendered these accidents more intense. Mad. N. 
experienced severe pain in sexual congress ; many 
physicians were consulted, and different remedies w^ere 
prescribed, but unsuccessfully. Dupuytren, having 
been advised with in this case, examined carefully the 
state of the parts, and detected a malformation of the 
end of the neck of the uterus, which had the form of 
a hook. The whole circumference was painful, glis- 
tening and ulcerated in several points. This skilful 
surgeon could suggest no mode of cure but incision, 
which was performed several days after with perfect 
success : the menstrual discharge reappeared at the 
usual period, and four months afterward, Mad. N., 



. li 



IN THE MALE AND FEMALE. 



193 



who had hitherto given no mark of fecundity, became 
pregnant. 

12. Deviations in the Position of the Uterus. — ^^Ster- 
ility often depends on certain displacements of the 
uterus, among which may be noticed its descent, its re- 
version, its anteversion, its retroversion, its hernia. 

1. Descent. — Before coming from the sexual parts, 
the uterus may undergo several degrees of displace- 
ment which have been termed collectively incomplete 
prolapsus. This circumstance has seemed in many 
cases to oppose fecundation, either by changing the 
natural relations of the sexual parts during conju- 
gal intercourse, or by rendering this more or less 
painful by a kind of collision which the penis then ex- 
ercises on the neck of the uterus. 

These different degrees of prolapsus are seen in the 
annexed figures, the first one showing the natural posi- 
tion of the uterus. 

[Fig. 26.] 





a. The vagina. 
5. The uterus. 



Partial descent of the uterus, 
a, a, a. Vagina. 6. Uterus. 



17 




Prolapsus uteri, a, a. Vagina. 6. Uterus. 



194 STERILITY CAUSES TREATMENT 

In treating of defects in the dimensions of the pe- 
nis, I have had occasion to speak of the mechanical 
means proper to render coition less painful to the fe- 
male, and I shall confine myself to relate an observa- 
tion which seems to me to confirm this. Mad. de 

St. , aged twenty-four years, had been married 

seven years, and had no family : the husband and wife 
apparently enjoyed all the attributes of their sex, and 
also desired children, when Mad. S. came to my mai- 
son de sante for a disease of the skin w^ith which she 
had been affected for several months. Having inform- 
ed me of her sufferings during sexual congress, I 
examined the neck of the uterus, wdiich I found lower 
than usual, directed to the left and backward, and 
slightly curved on itself. I learned from the husband 
that he was excessively strong, and this rendered coi- 
tion painful. To rem.edy this double inconvenience, 
I prescribed for Msd. S. the use of hip-baths and mu- 
cilaginous injectioiiS. I then applied a semi-specu- 
lum (seen in fig. 25, p. 187), to bilng the neck of the 
uterus into its n^naral position, and at the same time 
recommended to apply to the vulva, during coition, a 
gum elastic ring perforated in the centre to receive the 
penis and shorten it. By pursuing this course, Mad. 
S. soon became a mother. 

In complete prolapsus, the uterus gradually passes 
through the whole of the vagina, and is more or less 
perceptible between the external labia, so as sometimes 
to present the appearance of hermaphrodism. This 



IN THE MALE AND FEMALE. 195 

accident would necessarily imply impotence, and, con- 
sequently, sterility, if art did not return the uterus and 
keep it fixed by a pessary : but not unfrequently in this 
latter case, the female conceives and goes her full time. 
I have even known a lady who became pregnant after 
the reduction of a complete prolapsus of the uterus, 
and who, after her confinement, had but a slight dis- 
j^lacement of the neck of the uterus which now 
scarcely descends to the inferior strait. 

2. Inversion of the Uterus, — Although the inversion 
of the uterus is most generally the immediate result of 
parturition, there are cases where it is caused solely by 
debility, or by causes which tend to distend the uterus, 
as dropsies, uterine hemorrhages, &c. Whatever may 
be the degree of prominence of the tumor, sterility al- 
ways attends it. 

It is not difficult to reduce the uterus which has suf- 
fered this kind of displacement, but it is sometimes 
troublesome to prevent relapses, especially if the affec- 
tion be of longstanding. When the first intention has 
been fulfilled according to the different rules indicated 
for the taxis, a pessary should be applied, and abso- 
lute rest should be prescribed, and the horizontal pos- 
ture should long be maintained ; injections and douches 
of sulphurous or ferruginous mineral waters should be 
used. Many females have been known to conceive 
after the reduction of more or less complete inver- 
sions of the uterus, but it is especially important to 



196 STERILITY CAUSES TREATMENT 

avoid the consequences of a new inversion after partu- 
rition. 

3. Anteversion, Retroversion^ and Obliquity of the 
Uterus. — The deviations of the neck of the uterus, 
which arise from some displacement of the body of 
this organ, are rarely causes of steriHty, as they are 
most generally the product of gestation. If it should 
happen that any degree of inclination occurs in the 
neck of the uterus, and this circumstance seems to 
impede fecundation, it would be extremely necessary 
to employ the speculum, the efficacy of which has 
been confirmed by several cases already mentioned, 
and particularly by the following : — 

Mad. , aged thirty-nine years, had remained 

barren for nearly twenty years, in a union contracted 
against her taste, and the wishes of her parents. In 
1809, Prince Kourakin, with whom she was intimately 
connected, and who honored me for a long time with 
his particular esteem, wished me to treat her for an as- 
cites which disappeared in a little while. Mad. 

manifested on this occasion the most lively interest to 
have a family : she had already consulted for this Prof. 
Halle and Dubois, who had advised her to lake mine- 
ral waters, but without success. On returning she 
consulted me again, and submitted to an examination. 
In this exploration I had much difficulty in finding the 
neck of the uterus, the extremity of which was situa- 
ted behind the pubis. This last circumstance, which 
seemed to me to be the cause of the sterility of mad- 



IN THE MALE AND FEMALE. 197 

ame, was attended with a kind of genital coldness, 
which I treated by proper remedies, and especially by 
the anti-anaphrodisiac syrup : to ascertain the efficacy 
of such remedies, I placed two setons in the loins 
which caused an erysipelatous eruption, extending to 
the whole of this region. After waiting for some 
time for the effect of these different remedies, I intro- 
duced a demi-speculura, to keep the uterus in its nat- 
ral position. It was by the aid of this apparatus that 

fecudation occurred, and the desires of Mad. 

were gratified. 

Madame R., of Creole origin, and of a very deli- 
cate temperament, married, at the age of eighteen 
years, a French officer, whom she loved passionately. 
For about fifteen years, they lived together, at Martin- 
ique—their union was sterile. Despairing at not hav- 
ing children, they came to Paris at the beginning of 
1820, to try the effect of the climate of France ; and, 
at the same time, to employ professional advice. On 
their arrival at Paris, they consulted Prof. Dubois, 
who found the neck of the uterus situated anteriorly, 
projecting unusually far into the vagina. Prof. Du- 
bois attended to the general health of Madame R., 
and prescribed for her a tonic treatment, which was 
followed by good effects. Not being able to attend 
the patient carefully, I tOok charge of her. After 
continuing the same remedies for some time, I pre- 
scribed the use of the anti-anaphrodisiac syrup, and 
that of frictions, with the asterasic pommade, which 
17* 



198 STERILITY CAUSES TREATMENT- — 

caused an unusual degree of excitement in the genital 
organs. To correct the malposition of the neck of 
the uterus, I appHed the metrastere immediately after 
the menstrual discharge, and repeated its application 
three times, very soon after this period. After some 
time, Madame R. became pregnant, and was happily de- 
livered of a healthy child. We have known three other 
cases, of ladies who have been sterile from bad posi- 
tions of the uterus, and who have become mothers, 
from the same process.^ 

Diseases of the Falloyian Tiibes, 

The diseases of the tubes are quite as difficult to 
detect as those of the ovaries, which they almost in- 
separably attend. Their inflammation, which is ne- 
cessarily the result of that of the uterus and ovaries, 
may cause contraction, or even the complete oblitera- 
tion of their passage, and thus become an incurable 
cause of sterility. This closing exists much more fre- 
quently at the peritonoeal than at the uterine extremity 
of the tube. There is one pathological fact which is 
almost constant — that the free faces of the mucous 
membranes unite with great difficulty, while the serous 

* To use the metrastere, the vagina should first be dilated by oily in- 
jections, and emollient hip-baths, and the female should be placed on the 
edge of the bed, with the knees raised and separated; one end of the 
instrument is then introduced into the vagina with one hand, and the other 
end grasps the neck of the uterus, and directs it into a part of the passage 
to receive and fix it. It is then kept in place by bands fixed around the 
pelvis, or the female keeps it in place by holding it with the hands. 



IN THE MALE AND FEMALE. 199 

membranes contract and form lesions with the greatest 
facihty. It is about the sloping orifice of the uterine 
tubes, that the continuation takes place between the 
mucous membrane of the sexual organs of the female, 
and the serous membrane which lines the abdomen* 
We shall readily understand that, as the mucous mem- 
brane changes, in a measure, into a serous membrane, 
it acquires the properties of the latter; and as after a 
metroperitonitis, or a peritonitis, the fimbriated ends 
of the tubes adhere together, and partially or entirely 
obliterate the canal of the tube. 

The Medical Gazette, of Paris, for September, 
1838, says, and with reason, that every cause of peri- 
tonitis might become a cause of sterility, especially if 
it begins in the pelvic organs ; and as it is exactly in 
these organs that the peritonitis of females commences, 
we have already one reason for the frequent obliteration 
of the peritoneal extremity of the tubes, coinciding 
with the adhesions between the internal genital organs 
and the surrounding parts. 

It follows that the numerous instances of sterility I 
have seen, have supervened after pathological lesions 
of the pelvic viscera ; whether these females have had 
one or more children, or have borne none. Let us 
examine this practical fact, when a more or less acute, 
a more or less vivid inflammation commences In the 
uterus, and thence, extends continuously into the 
two tubes ; we can easily see that at the place where 
the mucous is changed Into a serous membrane, in- 



200 STERILITY CAUSES TREATMENT 

flammation causes the secretion of a lymphatic fluid, 
which unites the fimbriated edges of the tubes, and 
thus, abnormally, closes one or both of them. 

I ought to mention, also, that everything which may 
cause or excite inflammation, or may irritate idiopa- 
thically or sympathetically, the genital organs of the 
female, may produce sterility, by diminishing the cavi- 
ty of the tubal orifice, or by causing the entire oblit- 
eration of the tubes; this also occurs simply by the 
presence of mucus, or other foreign bodies, in the 
passage ; but it is as difBcult to detect these as it is to 
remedy them. It is with a view to cleanse these tubes, 
and to favor the displacement of foreign bodies which 
might interrupt the continuity of their channels, that I 
have frequently attempted, and not without difficulty, 
but sometimes with unexpected success, to introduce 
injections into them, by means of sounds properly 
arranged. 



ARTICLE II. 

Sterility de^pendent on General Causes Inherent in the Constitution 
of the Female. 

In order to conform to the plan adopted in stating 
the causes of sterility in man, we refer also to two 
principal heads — that is, to physiological and patho- 
logical causes, all the circumstances which may give 
rise to this kind of sterility in the female. 



IN THE MALE AND FEMALE. 201 

§ I. PHYSIOLOGICAL DISPOSITIONS. 

1. Ages. — The period during which the female 
possesses the reproductive faculty, is naturally marked 
by a function, which fixes its duration, as it were, in 
an absolute manner. But before the full period of 
menstruation has passed, the genital organs are fre- 
quently nullified by the progress of age. In fact, 
many females present apparently all the physiological 
conditions required for conception, but are unable to 
become mothers, because the uterine system loses the 
degree of vitality which must render it fit for fecunda- 
tion. This kind of sterility seems especially to await 
the female who does not enter the married state till 
she has attained a certain age, and when the want of 
exercise of the genital organs has absolutely enfeebled 
the reproductive life, so as to annihilate its functions. 
Thus, for instance, a female who marries at forty years 
of age, conceives with much more difficulty than she 
who is married at twenty, although both have the same 
sexual attributes. 

Sterility depending on late marriage has often been 
treated, successfully, by stimulants of the uterine sys- 
tem, especially by sulphurous douches on the loins, 
flying blisters, anaphrodisiac liniments, &c. ; but it is 
proper to wait for the employment of these remedies, 
as well as for the congress of the sexes, till after 
menstruation has occurred, because then the uterus 
possesses a certain degree of excitement, and its ori- 



202 STERILITY CAUSES TREATMENT 

fice, being partly open, permits the admission of the 
semen. 

2. Temperament* — The uniformity of temperament 
and of constitution, which forms one of the principal 
characters of the female organization, seems to render 
it tributary to the same laws. The sanguineo-lym- 
phatic temperament with which it is generally endowed, 
appears also to be more favorable to conception, and 
hence it has been remarked that those females who 
vary the most from this temperament are most subject 
to sterility. 

Those females who have a vivid, ardent tempera- 
ment, and who have a masculine form, a term applied 
by Horace to Sappho, are especially liable to sterility. 
We know also that females of a delicate constitution, 
with soft and loose fibres, and of excessive embonpoint, 
are generally sterile. Hippocrates thinks that the 
uterus Is chilled by the fat around It, and its orifices 
are then obliterated so as not to permit the penetration 
of the seminal fluid. But we think that we have 
given a just explanation of sterility produced by such 
a cause, by attributing it to an excess of nutrition in 
the other systems of the individual. 

Regarded solely In respect to the sensIblKty of the 
genital system, the temperament may be a frequent 
cause of sterility. Thus an erotic, ardent tempera- 
ment, more justly termed uterine by the learned Hal- 
ler, seems to be less favorable to fecundation than a 
temperament less sensitive to the enjoyments of love. 



IN THE MALE AND FEMALE. 203 

If fecundation requires on the part of the man ardent 
desiresj it demands of the female only pleasant com- 
plaisance and tender affections. Look, for instance, 
at those sterile females who are sometimes vivacious, 
ardent, and irritable, and sometimes, on the contrary, 
cold, indolent, and inaccessible to love. They are, 
for the most part, in opposite physiological conditions, 
while it has been remarked that those females placed 
between the two extremes, that is, who have a consti- 
tution both sanguineous and lymphatic, and a moderate 
degree of embonpoint, and passions rather amiable 
than violent, are the most liable to conceive, and make 
the best mothers. 

The principal steps in the treatment of sterility from 
the causes we have mentioned, are to modify the geni- 
tal sensibility, either by moderating the excess of the 
venereal orgasm, or by soliciting the fluids toward the 
uterine system when vitality is distributed unequally 
over the economy. This treatment has already been 
indicated before, and should be modified according to 
the special sensibility of the patient, observing faith- 
fully the adage of the ancients, which is here true, — 
Contraria contrariis curantur. 

§ II. PATHOLOaiCAL DISPOSITIONS. 

When speaking of sterility in the male, we have 
seen that different pathological circumstances may 
render his genital organs impotent ; but this is not the 
case with the female, in whom reproduction is still far- 



204 STERILITY CAUSES TREATMENT 

ther removed from morbid influences. Every day, in 
fact, we see females give marks of fecundity even when 
affected with phthisis, scrofulous, scorbutic, venereal, 
and other diseases which endanger their own life, and 
that of the fetus. All the efforts of the physician, 
then, should tend solely to this latter object, and mar- 
riage should not be recommended nor can healthy and 
vigorous children be expected, till these affections are 
successfully treated. 



4 



IN THE MALE AND FEMALE. 205 



CHAPTER III. 

Of Pharmacology applied particularly to the genital apparatus, 
to modify the vital properties which govern their functions* 

Generation supposes not only the physical integ- 
rity of the organs specially devoted to this function, 
but It also requires certain physiological conditions, 
which art can not always detect. The different altera- 
tions of the vital properties which preside over this 
function, may be reduced to three states — Increase, 
diminution, and abolition. Although hygiene may. In 
both cases, supply the physician with powerful thera- 
peutic means, we must admit It to be Insufficient In a 
great many cases, where we are obliged to use differ- 
ent substances which belong to the materia medlca. 
All the substances employed by the profession to reg- 
ulate the type of sensibility of the genital organs, are 
naturally divided Into two classes : the first are gener- 
ally termed temperant remedies, and are composed of 
substances called cooling, emoUIents, gummy emul- 
slves, opiates, &c. As most of them are known both 
in their physical, as well as in their medical characters, 
we have not thought It necessary to examine them par- 
ticularly ; but this Is not the case with those compo- 
sing the second class, which are usually termed afhro- 

18 



206 STERILITY CAUSES TREATMENT 

disiacs, and which seem to us to merit a particular 
description. 

§ 1. SUBSTANCES USED TO DIRECT THE FLUIDS TO, AND 

PRESERVE THE VITAL PROPERTIES IN, THE GENITAL 
ORGANS OF THE TWO SEXES. 

Some physicians have denied the existence of 
aphrodisiacs, but without reason, as may be seen by 
observing what occurs in animals. We know that 
marum excites cats, as do also, catmint, valerian, and 
Virginia snake-root; and hempseed, fenugreek, &c., 
render birds salacious. 

Aphrodisiacs are much sought after, especially in 
warm climates, where they are used particularly by 
the Orientals, because the heat, polygamy, and exces- 
ses of every kind, soon diminish, and even destroy 
their virile powers. Certain aromatic odors excite the 
uterine system in many females. 

We are all familiar with the history of one of the 
wives of Jacob, who used an aphrodisiac, and about 
which Bible commentators have disputed much, as to 
what plant was used, although now it is generally 
regarded as the mandrake. 

The three kingdoms of nature contain aphrodisiac 
substances — 1, in the mineral kingdom we find the 
astites or eagle-stone, a carbonate of iron, the astroites 
or star-stone, a carbonate of lime, sea-salt, borax, &c. ; 
2, in the vegetable kingdom, several varieties of the 
mushroom have aphrodisiac properties, especially truf- 



IN THE MALE AND FEMALE. 207 

fles, and morels, or red mushrooms, the ginseng of 
Japan, vanilla, salep, cacao, asparagus, certain of the 
alliaceae, the root of John of Lopez, the cardamoms, 
and the arum, the arlstolochlce, the laurels, canella, 
the muscadine, laurea persea, opium, cloves, several 
balsams, oils or essences, and other vegetable substan- 
ces, which act more or less powerfully. The animal 
kingdom presents a great number of these substances. 
The fluids, and even the odor, of the sexual organs, 
are powerful aphrodisiacs* The same may be said of 
musk, castor, civet, sincus officinalis, a kind of lizard 
which feeds on insects, and the hawk's-bill turtle ; the 
last two act on the urinary and sexual organs, as do 
other fishes which contain phosphorus. The cuttle- 
fish, the pulp, the periwinkle, the oysters, and other 
bivalves — crabs, lobsters, shrimps, and most of the 
crustaceae, enjoy the same qualities ; and for this rea- 
son they are used so freely by the Venetians and Flo- 
rentines. 

1. Vegetable Kingdom. 

(Stalks, Leaves, and Flowers.) 

1. The Summer Savory {Satureia Hortensis), of the 
natural family of the labiatoe, corolla with five nearly 
equal lobes, stamina distant, stalk two decimeters high 
and frequently more, and a little reddish ; leaves lance- 
olate, linear ; flowers small, reddish, axillary, gemellar 
on each peduncle. This plant grows naturally in the 



208 STERILITY CAUSES TREATMENT 

dry places of the southern provinces, and is cultivated 
in our gardens. It is an annual. 

Properties. — The summer savory has been classed, 
and with reason, among stimulating medicines. I use 
the whole plant in infusion, and the powder in differ- 
ent doses. 

2. The Catnip {Nepeta Cataria), of the natural family 
of the labiatoe ; calyx cylindrical, with five dentated 
teeth, the stalk from six to ten decimeters high, and 
quadrangular, leaves petioled, cordate, tooth-serrate, 
green above, white underneath ; flowers in whorled 
spikes ; color, generally purplish, sometimes white. 
It is found on the edges of roads, in damp places. 
Perennial. 

Properties. — This plant has a strong odor ; and for 
this reason, is much sought after by some animals, 
especially cats, in whom it seems to develop venereal 
desires ; hence, it is termed catnip, or catmint. I 
use the whole plant, but more particularly the flowers. 

3. The Miiit (Menthce), of the natural family of the 
labiatoe, present the following characters : corolla a 
little longer than the calyx, with four nearly equal 
lobes, that of the centre being a little broader, stamens 
equal, erect, distant. We distinguish two varieties of 
mint, viz. : — - 

(1.) The Mentha Crispay the flowers of which are 
in long, continuous, and terminal spikes, the leaves 
serrated and hairy, especially underneath. This is 
distinguished, also, from the Mentha Rotundifolia, as 



IN THE MALE AND FEMALE. 209 

in this latter, the stamens stand out from the corolla, 
while in this variety, they are within it. This plant is 
found among rubbish, which is moist, and near walls. 
It is perennial. 

The Mentha Crisjpa has a very marked smell and 
taste, and, for this reason, has been placed among the 
stimulant remedies. I use the whole plant. 

(2.) The Peppermint {Mentha Piperita) differs 
from the preceding by the following characters : its 
pedicles are always glabrous, its stalk is from three to 
six decimeters high, straight, and glabrous ; its leaves 
ovate-oblong, acute, serrate, rounded-crenate at the 
base, petioled, and smooth ; flowers small, and red- 
dish ; stamens shorter than the corolla ; calyx striate. 
It is a native of England. 

Properties. — These are extremely analogous to those 
of the preceding, but its action is more powerful, 
and its smell and taste more marked. 

4. Asparagus {Asparagus Officinalis), of the natu- 
ral family of the asparagi ; flowers pedunculated, of a 
yellowish green, arranged at the origin of the branches ; 
the stalk straight, round, green, and panuled at its 
upper part ; its leaves are linear, soft, and arranged by 
from two to five in fasciculi, at the base of which we 
find an extremely small membranous stipule ; the root 
is round, and gives off radicles. It is perennial, and 
is easily propagated by dividing the roots. 

Properties. — The root of this plant has long been 
classed among the diuretics, and several pharmacolo- 
18* 



210 STERILITY CAUSES TREATMENT 

gists have placed it amon^ those substances, which 
increase the secretion of semen. The young stalks, 
and all the green parts of the plant, possess this prop- 
erty in an eminent degree. In some cases, I have 
derived much benefit from its use. 

5. The Cineraria Siberica, of the natural family 
compositoe, order corymbiferoe ; flowers radiated, the 
tubular floscular flowers are hermaphrodites, while the 
semi-floscular flowers are fertile ; the aigretts are sim- 
ple and sessile ; the unvolucrin is composed of several 
petioles, also, arranged in one row ; the flowers are 
terminal ; the stalk is about one metre high, simple, 
striated, very smooth, and a little purplish at the base ; 
the petiolated leaves are entirely smooth ; the radical 
leaves are rounded. This plant is perennial. It 
grows in the marshes near the mountains. It flowers 
at the beginning of summer. It is found near the 
Eastern Pyrenees, &c. 

Properties. — This plant has very great virtue as 
increasing the secretion of semen. I use the whole 
plant, except the root. 

6. The Brasica Eruca, of the natural family of the 
cruciferoe, order siliquosoe, flowers with four cruci- 
form petals of a pale yellow color marked with violet 
and blackish veins ; the stalk is five decimetres high ; 
its leaves are long, petiolate, tender green, and almost 
glabrous. This plant is an annual ; it grows in the 
fields and uncultivated places in the south of France. 

Projjerties. — The rocket is a powerful aphrodisiac, 



IN THE MALE AND FEMALE. 211 

consecrated to Venus by the ancients, as may be seen 
by this line from Martial : — 

" Excitui ad venerem tardos eruca maritos." 

I have obtained marked effects from the use of this 
plant, and recommended for use the leaves at the time 
of flowering. 

7. The Eryngo {Eryngium Campestre), of the natural 
family of the umbilliferoe ; flowers arranged in umbels, 
the petals of which are oblong ; the umbels terminal, 
small, and very numerous ; the fruit oval, oblong ; the 
stalk grows about three decimetres high ; it is straight, 
cylindrical, striated, whitish ; its leaves are hard, green, 
and nervous. This plant is remarkable, resembling in 
in some respects a thistle, although it has all the char- 
acter of the umbilliferoe. It is perennial, and is seen 
on the edges of roads, and in barren plains. 

Properties, — Of this plant we use only the root, 
which is classed among the diuretics, emmenagogues, 
and aphrodisiacs. It generally presents at its upper 
part a mass of hair formed by the remnant of the 
leaves of the preceding year : they are remarkable 
especially in spring, before the plant has put forth its 
new leaves, and these fibres have given it the name of 
goat's beard. 

8. The common ave?is, herb Bennet, — gcinn urha- 
num, of the natural family of the rosaceoe. Tube of 
the calyx concave ; limb five-cleft, externally five- 
bracteolate ; petals five ; stamens numerous ; carpel 



212 STERILITY CAUSES TREATMENT 

juiceless, tailed, disposed in a head ; style after flower- 
ing, articulate or barbed ; seed ascending ; leaves va- 
riously pinnatisect ; stem erect, branched, hairy, usu- 
ally five decimetres high ; stipules somewhat orbicular, 
large ; petals obovate, as long as the calyx ; styles 
smooth with somewhat hairy appendices. The root 
long, size of a large quill, and surrounded by nume- 
rous reddish radicles of an astringent taste, and an odor 
similar to that of the gelliflower. This plant is peren- 
nial and grows in woods. 

Properties. — Of this plant I use only the root, which 
has a bitter and austere taste, which it imparts to boil- 
ing water, wine, and alcohol. Most naturalists have 
arranged it among the tonics ; but it seems to act as an 
aphrodisiac, and favors the accumulation of the blood 
in the genital organs. 

9. The Actoea Racemosa, of the natural f-^.mily of the 
ranunculaceoe ; corolla with four petals; calices with 
four caducus follicles. This plant is perennial, and is 
found naturally in South America ; it occurs also in 
Virginia, Canada, &c. 

Properties. — Of this plant I only use the root dry, 
and in small doses : it has an acrid taste and a fetid 
odor ; when employed carefully it is a powerful aphro- 
disiac. 

10. Salep comes to us from Turkey and Persia, 
and is furnished by several species of the orchis, as 
the orchis mascula and the orchis morio, of the natural 
family of the orchideoe : the stygma is convex, and 



IN THE MALE AND FEMALE. 23 3 

placed forward of the style ; the anther is in two 
compartments at its summit ; the pollen forms two ob- 
long masses ; the fruit is a capsule with three valves, 
which open with three longitudinal fissures, and con- 
tain a large number of seeds. These plants are peren- 
nial. 

The salep, as it comes from Turkey and Persia, is 
in small ovoid balls, strung on a piece of thread like 
a rosary : they are of a yellowish gray color and semi- 
transparent, and of a horny fracture : salep has a feeble 
odor which arises from the melilot ; its taste is muci- 
laginous and slightly saltish ; it contains a great deal 
of starch, and is powdered with great difficulty ; it is 
used most generally in the latter state. 

Properties. — The powder of salep is of a yellowish 
white, and readily unites with water; its molecules 
suck in this liquid, which soon acquires a glutinous 
consistence. 

The salep must be arranged among the analeptic 
and aphrodisiac remedies : incorporated in a great 
number of preparations it is an excellent remedy from 
which I have obtained very fortunate results, especially 
in cases of exhaustion and marasmus. 

11. The root of John of Lojpez {radix Lopeziana). 
— The vegetable which furnishes this root is unknown, 
and its name belongs to a Portuguese traveller who 
first introduced it into Europe. The tree to which it 
belongs grows in the East Indies. This root which 
varies much in size, comes in the form of sticks, some- 
17* 



214 STERILITY CAUSES TREATMENT 

times eight inches long and two inches in diameter : 
in some cases it is a ligneous trunk which measures 
from five to six inches in diameter : the wood is of a 
yellowish blue, lighter than water, and susceptible of 
receiving a fine polish. This root has a bitter taste : 
it is inodorous ; its bark is brown, compact, bitter, and 
covered with a yellow, spongy, and downy epidermis. 
This root is very scarce and dear, and it is a good 
aphrodisiac, which I have introduced into several of 
my formulae. I give it sometimes mixed in pow^der, 
at other times in infusion and decoction. 

12. The Convolvulus Scoparius. — This substance, 
which several authors regard as a root, because, in 
fact, it presents all the external characters of one, has 
also been termed Bois du Roses, from its perfume. 
Latterly it has been brought from the Canary islands, 
where it is furnished by an arborescent creeper, of the 
natural family of the convolvulacoe, one or two inches 
in size, whitish and reddish yellow internally : it has 
an odor of roses, which is very perceptible when it is 
crushed ; its taste is slightly bitter ; it sometimes ig- 
nites at the approach of a lighted candle ; the heaviest 
and most deeply colored should be chosen. We ob- 
tain from this wood by distillation a volatile oil of a 
very strong odor, which is somewhat analogous to that 
of the rose. 

Properties. — This substance, which has been ar- 
ranged among the class of tonic and stimulating drugs, 
is a good anaphrodisiac. I have often used its alco- 



IN THE MALE AND FEMALE. 215 

holic tincture, its essential oil ; I also employ the aque- 
ous or vinous infusion, &c. 

13. Japan Ginseng [S'mm Ninzi, panax qiiinquefo- 
Hum). — The natural history of the ginseng root is still 
a subject of dispute with naturalists. Sonne attribute 
the ginseng of Japan to the slum ninzi^ of the fannily 
of the umbelliferce ; others consider it as belonging 
to the panax qiiinquefolmm, very near the former. As 
we do not propose to enter into a discussion of the 
queiition here, we shall simply point out the characters 
v/httch distinguish this root. It is about two inches 
long ; its size is most generally that of the little finger ; 
it is a little knotty, brilliant, and semi-transparent, 
often divided into two branches, sometimes, into a 
great many twigs ; it is fibrous toward its base, red- 
dish outside, yellowish inside ; its taste is slightly 
acrif^, a little bitter, and aromatic, and of a peculiar 
odor, which is not disagreeable. This root is rare in 
Europe. 

Properties, — Without admitting the wonderful state- 
ments made by the Chinese in regard to this plant, it 
certainly enjoys aphrodisiac qualities in a very great 
degr'^e ; we have used it with success in tincture, in 
aqueous and vinous infusion, in cases of muscular de- 
bility, exhaustion, and marasmus. Hence, it enters 
as an essential principle, in preparations which have 
for their object, to excite the genital organs, which 
have been abused by premature indulgence. 

14. Tniffies {Tube?' Ciharium^ Ly coper don Tuber) ^ 



216 STERILITY CAUSES TREATMENT 

of the natural family of mushrooms, are fleshy, round- 
ed, subterranean tubercles, which present internally 
veins directed in different directions. They are almost 
entirely destitute of root, and differ from the lyco- 
perdon, in which Linnaeus had classed them, as they 
are not filled with dust. 

The Tuher Cibarium is of a blackish or gray color, 
destitute of any kind of radicle ; its external surface 
presents small, and almost prismatic, and warty emi- 
nences ; its parenchyma is firm, and is not changed 
by drying ; of this, we distinguish three varieties — the 
black, gray, and violet. The first is black outside 
and blackish inside, where it presents reddish lines 
arranged in a network ; the second is at first whitish, 
and then becomes an ashy brown ; the third is usually 
a dark violet. The truffle delights in light and grav- 
elly soil, especially in forests planted with oaks and 
chestnuts, and is covered by about two centimeters of 
soil ; its odor is so penetrating as to be perceptible to 
hogs and dogs for some distance, and it is by these 
animals that the peasants detect its localities. 

Properties. — The odor and taste of the truffles are 
so pleasant that they are sought after by bon vivants. 
Taken as food, they soon show their stimulating ef- 
fects on the genital system. Employed as a medicine, 
they have an aphrodisiac power, which is very well 
suited to persons of a lymphatic temperament. 

15. The AUiaceoe, of the natural family of the 
iliaceae, flowers terminal, umbellated. They pos- 



IN THE MALE AND FEMALE. 217 

sess, and justly, the reputation of being excellent 
aphrodisiacs. The Allium Sativum., in particular, 
seems to be eminently endowed with this power. Its 
odor penetrates all the tissues and fluids of the differ- 
ent secretions, in persons who use it, and seems to 
exercise special influence on the genital organs of 
both sexes, as Martial has stated in the following 
distich : — 

" Qui proestare verim Cyprioe certamine nescit, 
Manducet bulbos, et bene fortis erit." 

16. The Amomum Cardamomum. 

17. Amomum Grana Paradisi. — The two plants 
which furnish these fruits belong to the natural family 
of the zingeberaceae. The first is seen in the East- 
Indies, on the coast of Malabar, and in the island of 
Java; the second grows in Africa, and its fruit is called 
maniguette, or, grains of Paradise. The fruit of the 
amomum cardamomum has the form of a membranous 
and papyraceous triangular capsule, with three parti- 
tions, each containing ten irregularly shaped seeds, 
somewhat analogous to cochineal. These seeds have 
a piquant taste, and a strong and aromatic odor. The 
amomum grana paradisi has the same form as the 
preceding, is of a grayish brown color, and has a cam- 
phorated smell. It is also larger. 

Properties, — These two fruits have stimulant prop- 
erties, which manifest themselves particularly on the 
genital system. I generally combine them with other 
substances, to increase, or to modify their effects, 

19 



218 STERILITY CAUSES — TREATMENT 

according lo the particular disposition of the sub- 
jects. 

18. Seeds of the Vitex Agmts Castns. — The tree 
which furnishes these seeds belongs to the natural 
family of the pyrenacese, which resemble the lablatae^ 
but differs by the irregular tabular corolla, of a violet 
or purple color ; the calyx is short and whitish ; the 
stamens are prominent. The agnus castus grows 
naturally in moist places of the southern provinces* 
It is odoriferous in all its parts. 

The fruit — the only part of the plant used, is 
jouncu and of the size of these of a pepper, blackish 
at tht ^jper part, and covered infeiiorly by the calyx^ 
which is permanent. When entire, they have a pleas- 
ant odor J but when broken, their smell is very disa- 
greeable. They have an acrid and aromatic taste. 

Projperties, — The name of this plant indicates the 
properties ascribed to it by the ancients. And they 
prepared from it a syrup, used to abate passion, in 
monasteries. It is always difficult to conceive that a 
substance, so aromatic, can have any effect, except to 
excite the genital organs. The experience of some 
modern physicians militates against this doctrine. I 
use the seeds of this latter plant in aqueous, vinous, 
and alcoholic infusion ; and I have them in several of 
my formulae. 

19. Seeds of the Cacao Theohroma. — The tree 
which furnishes these seeds belongs to the natural family 
of the malvaceae, and grows in South America. The 



IN THE MALE AND FEMALE. 219 

fruit in which the seeds are contained, has the form 
of a cucumber ; it is filled with a pulp, which contains 
a hundred seeds, similar to the almond — the interior 
of which is brown, and is divided into irregular lobes, 
separated by small white membranes. After the fruit 
is cooked, the seeds are removed ; they are then 
dried, and kept in the earth for several weeks, so that 
they may lose their acidity. 

The cacao most esteemed is the Caraccas, which 
comes from Nicaragua and Caraccas, on the Pacific 
Ocean. The Caraccas may be known by the grayish 
color of the epidermis, which adheres very slightly to 
the nut, which color it receives from being plunged in 
the earth for some time, to abstract from it its oleagi- 
nous principles. It is also rounder, its color is violet 
red internally, its taste is pleasant and agreeable, and 
it contains less oil than the other cacao. 

Projperties, — The cacao, especially that from Ca- 
raccas, has highly nutritive and stimulant properties. 
It is very useful in all cases of atony and consump- 
tion, when it is desirable to stimulate the organs, to 
excite that action which regulates nutrition, and to 
increase the spermatic secretion. I use the cacao 
under different forms, sometimes in powder or in 
pastiles, sometimes with sugar and vanilla, in the form 
of chocolate, and sometimes I combine it with salep 
and aromatic substances. 

20. The Vanilla J the fruit of the epidendrum vanilla^ 
of the natural family of the orchideoe, is found in Mexico 



220 STERILITY CAUSES TREATMENT 

and Peru : it occurs also in Cuba, Jamaica, and St. 
Domingo. The plant has a root in the earth, but the 
stalk is furnished with little radicles, which are inserted 
in the bark of the trees near it, which thus serve to 
nourish and support it, so that it may continue to ve- 
getate after it is removed from the ground. 

The Epidendrum Vanilla is cultivated in Mexico 
with great care, and we distinguish three varieties 
which produce three different fruits. One is larger 
and shorter, another small and long; the third is 
longer than the other two, and is almost inodorous. 
The vanilla has a straight pod, of a reddish brown 
color, corrugated in its length, and curved at its base ; 
it is flexible, often covered with a white crystalline and 
needle-shaped effloresence which arises from the ben- 
zoic acid which comes from it. It contains a soft oily 
blackish pulp, in which are a large number of black 
round and shining seeds. The vanilla contains a vol- 
atile oil and some benzoic acid, whence it derives its 
aromatic principles ; its taste is sweet and lasting ; its 
odor exquisite, and hence it is much used in confec- 
tionery. 

Proiierties, — Vanilla is classed, and justly, among 
the stimulating drugs ; taken in substance, in a proper 
vehicle, even in small doses, it excites the mucous 
membrane of the stomach, which communicates its ac- 
tion sympathetically and almost suddenly to the brain, 
and all the organs of sense dependant on it. Taken 
in large doses this substance carries into the blood 



IN THE MALE AND FEMALE. 221 

principles which cause the same excitement in all the 
systems of organic life, and especially in the genital 
apparatus to which it causes a greater afflux of blood ; 
thus it acts both as an aphrodisiac and emmenagogue. 
I introduce this substance into many internal reme- 
dies and external applications. I administer it also in 
substance, either alone or combined with other medi- 
cines in vinous and alcoholic infusions ; in both cases 
I incorporate the oil obtained from it in pommades, 
liniments, &c. 

21. Ojpium, the juice of the pajpaver somniferum, of 
the natural family of the papaveraceoe, is obtained by 
the expression or decoction of the plant, and is im- 
ported in the form of round cakes, from four to sixteen 
ounces in weight, which are covered with leaves of the 
poppy or other narcotic plants. We ought to select dry 
and pure pieces, w^hich have a clean and shining frac- 
ture, strong and powerful odor, bitter, nauseous, acrid, 
and permanent taste ; it ought to be soluble in great 
proportion in water, soften under the fingers, and burn 
readily. 

Properties. — Opium should not be employed as an 
aphrodisiac, except in very rare cases, and with the ut- 
most discretion. For although the Orientals use it to 
excite to the contests of Mars and Venus, its prolonged 
use finally depresses and even destroys the genital 
powers entirely. 

22. Balsam of Mecca (Balsamum Meccanense). 

23. Balsam of Tula {Balsamum Tolutanum). 

19* 



222 STERILITY CAUSES TREATMENT 

24. Balsam of Peru {Balsamum Peruvianum). 

25. Balsam of Benzoin {Balsamum Benzoeum). 
We shall include under one head our remarks on 

the four balsams which resemble each other in their 
physiological action. 

1. The balsam of Mecca, termed more properly 
Mecca turpentine, is furnished by the amiris opobal- 
samum, of the family of the terebintaceoe, which 
grows naturally in Arabia Felix, and is cultivated in 
Egypt and Judea. This terebinth or liquid resin is 
procured either by incisions in the trunk or branches, 
or by boiling the twigs and leaves in water : that ob- 
tained by incision is the finest : it is seldom seen in 
Europe. That commonly found presents the follow- 
ing characters : it is fluid, of a very agreeable and pe- 
culiar odor, whitish and opaque when fresh, but be- 
comes yellow and transparent by age, and at the same 
time grows dense and afterward solid. 

2. The balsam of Tolu is obtained from the bal- 
samum toluifera, the natural family of the terebinta- 
ceoe, a tree growing in South America, not far from 
Carthagena. This balsam is procured from the trunk 
of a tree by incisions made in it. It is generally solid, 
dry, and fragile when cold, but when exposed to heat 
it becomes semi-fluid, and runs easily, and forms a sin- 
gle mass. The color is a reddish yellow, semi-trans- 
parent ; its odor is extremely pleasant, and it has some 
analogy with a lemon ; its taste is sweet and agreeable ; 
it softens under the teeth, and becomes ductile, and 



IN THE MALE AND FEMALE. 223 

when thrown en coals it burns and gives aut a white 
aromatic and very agreeabk smoke ; it is entirely solu- 
ble in alcohol, or ether, and water removes from it a 
great deal of benzoic acid, when at the temperature of 
a sand-bath. In commerce, balsam of Tolu is gen- 
erally contained in large earthern bottles, and more 
rarely in small calebashes ; in the latter case it is softer, 
purer, and sweeter, and is then sold for the balsam of 
Peru. 

3. The haham of Peru is derived from the myroxi- 
lon peruiferum of LInnseus, or from the myrospermum 
peruiferum of Lamark and Jussieu, which have been 
• found to be identical. It is a large tree, belonging to 
the natural family of the leguminosoe, which grows in 
Peru, Brazil, and other parts of South America. 
There are three varieties of the balsam of Peru : !• 
the white; 2. the red; 3. the blacJc. The first is li- 
quid and almost transparent, and is obtained by incis- 
ions in the trunk of the tree. The second is solid, is 
collected in the same manner as the preceding. These 
two species are extremely rare in Europe : they are 
generally imported in calebashes, and are much esteem- 
ed for their purity and sweetness. The thr is the 
most common : it is fluid, of a syrupy consistence, of 
a very deep brownish reddish color, strong and very 
agreeable odor ; its taste is acrid, bitter, and disagree- 
able, by which it is distinguished from the balsam of 
Tolu ; it is entirely soluble in alcohol, and burns, 
when thrown on coals, with a thick smoke ; it gives 



224: STERILITY CAUSES TREATMENT 

off a great part of its benzoic acid to boiling water. 
When it remains a long time in a vessel, small white 
crystals of benzoic acid are deposited on its sides. 

4. Benzoin is a solid balsam which comes from the 
styrax benzoin, of the natural family of the ebenaceoe. 
This tree grows in the southern part of the island of 
Sumatra. It is also found in Java and Siam, and the 
benzoin flows from incisions made in the bark of the 
tree : at first it is liquid and whitish, but it soon be- 
comes colored and solidified by the contact of the air : 
it is asserted that each tree vt^ill give about three 
pounds, and the incisions may be continued for three 
or four consecutive years. 

There are two kinds of benzoin known in com- 
merce — the amigdaloid benzoin, and the sorted ben- 
zoin. The first is the purest and most esteemed, and is 
thus called as it comes in ovoid whitish tears, similar to 
almonds agglomerated in a brown and reddish paste ; 
the second is less pure, and presents a nearly uniform 
brownish tint. This balsam has a very agreeable odor, 
somewhat similar to that of the balsam of Peru ; its 
taste is aromatic, slightly acidulated and acrid ; its 
fracture is clean, shining, and vitreous ; it is friable ; 
it breaks under the teeth, and when thrown on live 
coals, it melts, burns, and gives off a thick whitish 
smoke, emitting a very strong odor, and irritating the 
throat. This smoke, when received and condensed 
in cold vessels, forms white crystals of benzoic acid. 
Benzoin is soluble in ether and alcohol : water then 



IN THE MALE AND FEMALE. 225 

precipitates its solution ; from this is prepared virgins' 
milk, a cosmetic preparation much used to render the 
skin smooth. 

Properties. — The four balsams just described, have 
very stimulant properties. When applied to living 
parts, they stimulate them, and develop in them an 
increase of vitality, and accelerate their motion. In 
confining ourselves to their effects on the genital sys- 
tem, we observe they modify the vital powers sensi- 
bly. Administered internally, or applied externally, 
they stimulate the surfaces with which they come in 
contact, and excite the genital organs to a greater or 
less extent. We observe, however, that their action 
is more marked as it is exercised directly on the geni- 
tal organs, and on the parts intimately connected with 
them. Thus, in certain cases of anaphrodisia, I have 
employed, with unusual success, plasters composed of 
these four balsams, or in combination with other sub- 
stances, with which I cover the lumbar region. 

26. The Cubeba {Piper Cuheha), also, deserves a 
passing notice, known, as it has been, from high an- 
tiquity, and many think that the Carpesium of Galen, the 
pepper of Hippocrates, and the round pepper of 
Theophrastus, all allude to this plant. The cubebs 
has been known in France and England for five hun- 
dred years. It is a native of Java, and the Prince of 
Wales' Island. Its stem is shrubby, terete, and climb- 
ing; the leaves petiolate, oblong, acuminate; pedun- 
cles almost equal to the petiole ; berries with elon- 



226 STERILITY CAUSES TREATMENT 

gated peduncles. In appearance, cubebs resemble 
black pepper, except that they are lighter colored, and 
are each furnished with a stalk two or three lines long ; 
within it, is a hard, spherical seed, which is whitish and 
oily. The taste of cubebs is acrid and peppery ; its 
odor is aromatic. 

Cubebs seem to exercise a specific influence on the 
genito-urinary apparatus ; and are much used by the 
Indians, who macerate them in wine, and take them to 
excite the genital system. Mr. Crawford says that in 
Malay countries, they are given in doses of three 
drachms, six or eight times during the day. I am 
satisfied that in many cases of sterility, cubebs may 
be a useful remedy. 

2. Animal Kingdom. 

27. The cantharides, an insect, of the natural fam- 
ily of the coleopterae, is from six to seven lines long, 
and from two to three broad ; of a green color, with 
black antennae. It is found in June and July, on 
several plants, where it is readily detected by its 
strong and disagreeable odor. This insect inhabits a 
great part of Europe, but is found in the southern 
parts, where it is gathered, killed by exposure to the 
vapor of vinegar, and then dried. 

Properties. — Cantharides have an acrid and caustic 
taste, a disagreeable and very penetrating odor ; the 
powder of these insects, applied to the skin and mu- 
cous surfaces, promptly causes very marked inflam- 



IN THE MALE AND FEMALE. 227 

mation ; if taken internally, and in large doses, it 
exercises the same action as irritating poisons, and 
causes all their symptoms ; as severe pain in the epi- 
gastrium, internal thirst, nausea, vomiting, severe 
colics, bloody dejections, hematuria, attended in man 
with obstinate and painful priapism, &c. Its use has 
sometimes caused death. Ambrose Pare relates the 
case of an abbe, who, to prove his powers, took a 
large dose of powdered cantharides — and died from 
it. Notwithstanding the danger attending its use, sev- 
eral physicians have prescribed it internally, to excite 
the urinary organs, in cases of dropsy, and atony of 
the bladder, or to induce the action of the genital or- 
gans, in cases of impotence. But the accidents which 
may attend or follow its administration, should lead to 
the greatest care in its use. I prefer the external 
application of this remedy, as the same effects may be 
obtained without presenting the same inconveniences. 

28. The Castoreum is the product of a particular 
secretion furnished by the castor fiber of Linnasus, of 
the class mammalia, order rodentia, inhabiting the 
north of Europe and America. They are also seen 
in France, Prussia, Poland, and Germany, but they 
live alone, and have none of the industrious habits of 
those dwelling in societies. The castor is secreted in 
two pyriform glandular pouches, situated at the under 
part of the skin of the abdomen, near the prepuce, 
and which has been confounded with the testes of the 
animal. The fluid they contain is liquid, yellowish, 



228 STERILITY— CAUSES TREATMENT 

and syrupy. In commerce, It is found in the pouches 
in which it is secreted, and one of which is always 
larger than the other. When removed from the ani- 
mal, the castor is soHd, has an acrid and bitter taste, 
strong, and even fetid odor, a blackish color exter- 
nally, and yellowish internally. Its fracture is resi- 
nous, and intermingled with whitish membranes. 
When recent, it preserves a certain degree of softness, 
and is then more odoriferous, and more sapid. But 
we must not confound this softness with that resulting 
from the action of moisture, to which the castor is 
exposed, and which is generally caused by the begin- 
ning of putrefaction. To avoid error in this respect, 
I advise to use the driest and most odoriferous. 

Properties. — The castor possesses excitant and anti- 
anaphrodisiac properties. When administered in sub- 
stance, in ethereal and alcoholic tinctures, &c., it is 
particularly proper for delicate and nervous persons. 

29. Ambergris, Ambra Cinerea. 

30. Civet, Zihethum, 

31. Musk, Moschus. 

As these last three medicines are endowed v/ith the 
same mode of action, it seems proper to describe them 
in the same article. 

(1.) Ambergris is a peculiar substance, which some 
naturalists consider as the excrementitious matter of 
the cachelot, physeter macrocephalus, of the class 
mammalia, order cetaceae, inhabiting the polar seas. 
It only forms in cases of disease. It is found floating 



IN THE MALE AND FEMALE. 229 

on the water, near Madagascar, Coromandel, the Mo- 
luccas, and Japan. This matter seems to have been 
liquid on its first formation, for it is often found in 
fishes and other marine animals. Ambergris comes in 
irregular, rounded masses, formed by layers of at least 
a pound in weight, and sometimes in much larger 
masses. The matter is solid, lighter than water, 
softening and melting like wax, by the aid of heat. 
Its color is gray, spotted with yellow and black, of a 
pleasant odor, very sweet and very expansible, almost 
entirely soluble in alcohol. This substance is rare 
and costly. 

(2.) Civet is furnished by two animals, of the class 
mammalia, termed viverra civetta, and viverra zibetta. 
It is secreted by glands, and deposited in a membra- 
nous pouch, situated between the anus and the genital 
organs. The animals which secrete it, are found in 
the warmest parts of Africa, and Asia, where they are 
bred very carefully ; in Abyssinia, also, some proprie- 
tors have three hundred of them. The civet is 
removed, by a spoon, from the pouch charged to 
receive the product of this secretion, and is kept in 
vessels closed hermetically. 

Civet is a semi-fluid, unctuous, whitish material, 
becoming brown and thick in the air, and has a very 
strong and disagreeable odor. In composition, it is 
somewhat similar to the castor. 

(3.) Musk is furnished by the moschus moschiferus, 
of the class mammalia, order ruminantia. It is con- 

20 



230 STERILITY CAUSES TREATMENT 

tained in a pouch situated near the genital organs, in 
front of the prepuce. Musk is strong in the animals 
inhabiting Thibet and China, and infinitely less so in 
those living in northern countries. The pouch for 
receiving the product of this secretion, does not fill 
till adult life, and this secretion occurs at the period 
of rutting. Musk has a semi-fluid consistence in the 
living animal ; but when it is separated, it becomes 
almost solid, unctuous to the touch, and of a blackish 
brown color, like coagulated blood. It has a bitter, 
aromatic taste, and a strong peculiar odor, which is 
very diffusible, and difficult to bear when concentrated, 
but pleasant when it is slight. 

Two kinds of musk are known in commerce — that 
of Tonquin is contained in pouches, the skin of 
which is yellow ; and that of Bengal, or rather of 
Thibet, known as kabardin, the skin of which is whit- 
ish and silvery. The latter is dry, less odorous, and 
its odor approximates to that of the aromatic plants, 
and it is less esteemed than the preceding. 

Properties. — These three substances have very re- 
markable stimulant properties ; their strong, pene- 
trating, and extremely diffusible odor, renders them 
very proper to act in a special manner on the brain, 
and to develop, in the whole organism, phenomena of 
reaction, which manifest themselves especially on the 
genital system. To attain this latter end, I have era- 
ployed them with equal success, either internally in 
the form of powders, potions, and pills, or externally 



IN THE MALE AND FEMALE* 231 

in the form of liniments, or pommades, to remedy the 
sterility which seems to result from an asthenic state 
of the sexual organs. 

Although there are still a great number of substan- 
ces capable of increasing the vital properties of the 
sexual system, we have confined our examination to 
those whose effects seemed more apparent. We might 
mention many other medicines, which have been 
regarded as producing the same effect ; but they act 
only from their stimulant properties ; they are un- 
certain in their results, and dangerous in their appli- 
cation. 



DIFFERENT PREPARATIONS USED EXTERNAL- 
LY FOR STERILITY. 

Asterasic Bath, 
^ Tinct. Benzoin, gx 

Tinct. Ginseng, § jv 

Tinct. Cineraria Siber., g ij 
Ambergris, 3 ss 

Ol. Rosar, Sj Mix. 

Uses. — The fluid is poured into the bath a few min- 
utes before it is wanted, using only half the quantity 
above mentioned, in the first four or five baths, which 
should be taken 26 to 30^ of Reaumur. 



232 STERILITY CAUSES TREATMENT- 



Another Bath. 




Tinct. Genievre, 




Tinct. Calami Aromat,. aa 


5iy 


Tinct. Menth. Pip., 


§y 


Tinct. Muscad., 


i iss 


Tinct. Ginseng, 


ijv 


Spir. Rosmaria, 


3 ij 



Mix. 



Asterasic Girdle. 

Eals. Peru, 

Bals. Gilead, aa § iv 

Put these two balsams in a glass retort, adapt to 
them a tube and a receiver, and distil with a gentle 
fire until you have obtained, in essential oil, a thirty- 
second part of the weight of these two balsams, or, 
two drachms of the above mixture. Put aside this first 
product of the secretion, and continue to distil till 
there remains in the alembic only a vitrifiable, resinous 
matter. Put aside this second product of distillation, 
and keep it in well-stopped vials, to use in other pre- 
parations, particularly for the asterasic pommade. 

On four ounces of the vitreous residue, add, after 
it is softened by fire, two drachms of essential oil, 
composed of equal parts of the following : — 

Essence of Rhodes wood ; [sams ; 

Essence, the first product of the distillation of the two bal- 
Pure essence of Neroli ; 
Essence of bergamotte ; 
Essence of Vanilla. 



IN THE MALE AND FEMALE. 233 

Liquify this emplastic mixture at a moderate tem- 
perature, and then spread it upon muslin, which has 
previously been sized by two layers of pure gelatine. 
The plaster should then be backed with silk or satin, 
to prevent the plaster from oozing through the cloth 
and sticking to the clothes, and also to concentrate its 
action on the part to which it is applied. 

These girdles should be about fifteen inches long, 
and five broad — sometimes even larger than this. 

When prepared, they should be rolled up with silk 
paper, slightly moistened with sweet oil, to prevent the 
adhesion of the surfaces ; and then placed in a case, 
to preserve the odorous substances from alteration. 

To increase the action of these girdles, I increase 
the proportion of the aromatic substances, add others, 
as musk, canella, ambergris, &c. 

These girdles should be applied to the lumbar 
region, directly above the insertion of the glutoei 
muscles, or the crests of the ossa ilia. 

First anti'Anaphrodisiac Liniment. 

R Balsam of Metz, g j 

Oil of Cantharides, § ss 

Oil of Rhodiola, ^ ij 

Essence of Neroli, 
Essence of Bermagotte, 
Musk, 
Ambergris 

Mix and make an ointment. 
20* 



J' 



5j 



. i aa grs. jv 

IS,) 



234 STERILITY CAUSES TREATMENT 

Second anti-Ayiaphrodisiac Liniment. 
^ Oil of Mint, } 
Oil of Ginseng, ) 

Oil of Cardamom, 3 j 

Tincture of iloot of Actosa Racemosa, | j 
Essence of Vanilla, 
Essence of Canella, 
Essence of Rhodiola, V aa 3 j 

Essence of Sage, 
Essence of Lavender, , 
Mix and form liniment. 

Third anti'Anaphrodisiac Liniment. 

'Anodyne Balsam of Bates, > 

Opodeldoc, > 

Oil of Mace, ^ 

Oil of Mint, 

Oil of Vanilla, 

Oil of Rhodiola, ^ 

Mix and form a Liniment 



> aa 3 ij 



Compound Tincture of Benzoin. 

Alcohol, g XV 

Distilled Water, g vj 

Liquid Balsam of Peru, f j 

Liquid Balsam of Tolu, § jv 
Distil In sand bath, after macerating for eight days, 
until you have obtained fourteen ounces ; then digest 
for a month in the product of distillation, 

Benzoin^ § jv 

previously reduced to an impalpable powder, and then 
filter. 



IN THE MALE AND FEMALE. 235 



First Asterasic Pommade. 
> aa 3 iij 

? aa 5 ij 



R Rose Ointment, 
Extract of Kino, 
Extract of Ginseng, 
Extract of Cardamom, 
Second product of distilla- 
tion for girdles, 3 ss 
Essence of Marjoram, > 
Balsam of Mecca, I ^^ ^^^ ""'^ 
Mix so as to obtain a perfectly homogeneous paste. 

Second Asterasic Pommade. 

R Extract of Vanilla, ") 

Extract of Ginseng, [> aa 3 ij 

Extract of Cineraria Siber., J 
Palm Oil, 



Rose Ointment, \ 



3 iij ss 



Second product of distillation 

for girdles, S j 

Essence of pure Neroli, > 

r? r T»u J- 1 ^ aa gttxij 

Essence of Rhodiola, > 

Civet, grs. ij 

Mix as before. 



236 STERILITY CAUSES TREATMENT 



DIFFERENT PREPARATIONS EMPLOYED INTER- 
NALLY FOR STERILITY. 

Royal Essence. 

Ambergris, 

Musk, 

Civet, 

Oil of Canella, 

Oil of Rhodes' Wood, 

Oil of Roses, > 

Oil of Orange Flowers, > 

Alcohol, 

Carbonate of Potash, 

Triturate together the amber, musk, civet, and car- 
bonate of Potash. Place this mixture in a flask, with 
the alcohol with which the mortar has been washed 
out, add the volatile oils, and digest for fifteen days, 
or leave the alcohol in it. Decanter, filter, and take 
by drops. Use it also as a lotion. 

Oriental Essence. 



grs. 


48 


Sj 




grs. 


X 


grs. 


xvij 


grs. 


vj 


^ttvj 


1 


iu 




gtt. 


vij 



Canella, 


m 


Cardamom, 


iij 


Galanga, 


iiss 


Ginger, 


5 iij 


Pepper, 


3 iij 


Nutmegs, 


3 iij 


Musk, 


sj 


Ambergris, 


grs. XX 


Alcohol, 


aij 



IN THE MALE AND FEMALE. 237 

Pulverize all the substances, except the ambergris 
and musk, which you must triturate separately, in 
alcohol. Place the whole in a flask, and digest for 
fifteen days. Filter, and use as before. 

Anti'Anaphrodisiac Syrup, principally for men. 

Ginseng Root, § iij 
Cinerarias Siberiae, ^ j 
Vanillae, ft j 
Seeds of Cardamom, mi- 
nor and Major, aa § ij 
Root of John of Lopez, ^ ss 
Cacao, ^ vj 
White Sugar, ft ij 

Musk, > 

^. } aS, q. s. 

Civet, S 

Ambergris, 3 ss Mix. 

Anti'Anaphrodisiac Syrup, principally for Females. 

Ginseng Root, g j 

Root of John of Lopez, ^ ij 

Persian Salep, § ss 

Wood of Rhodiola, f j 

Black Truffles, i ij 

Leaves of the Cataria, ^ j 

Vanilla, 3 jv 

Seeds of Cardamom, g ij 

White Sugar, ft ij 

Musk and Civet, aa q. s. 

Ambergris, 3 j 

Macerate all these substances in wine for fifteen 
days, then filter very carefully, and add the alcoholic 



238 STERILITY — CAUSES — TREATMENT — 

product of distillation. Bottle and cork up very care- 
fully. 

These two syrups should be prepared so as to retain 
all the extractive and volatile principles. Notwith- 
standing the difSculties attending their manufacture, 
M. Regnault, druggist, at Rue de Rivoli, No. 29, has 
found a mode which is extremely satisfactory. 

Ir may not be out of place to mention that these 
two preparations may be modified in accordance with 
the different physiological or pathological circumstan- 
ces. Thus I have often found it necessary to leave 
out the musk and civet, which seem to exert an unfa- 
vorable influence, even in many cases which were 
apparently the same. 

Asterasic Pastilles, 
R Cacao, i jv 

Ginseng Root, 3 jv 

Vanilla, 5 ix 

Canella, 3 ij 

Hootof ActoeaRacemosa, 3 j 
Sugar, ft j 

Musk, ^ j 

Ambergris, 3 ss 

Gum Tragacanth, q. s. 

Make a mass to be divided into 1000 pastilles, to 
be dried for use. 



IN THE MALE AND FEMALE. 239 

Tonic Asterasic Wine* 

Root of Zedoair, § ij 

Seeds of Agnus Castus, 3 vj 

Cascarilla Bark, § j 

Balsam of Acorus Calamus, 3 vj 

Alcohol, I viij 

Water, ft j 

Macerate for fifteen days, and distil in sand bath, 
to obtain eight ounces of distilled product. 

Dried Squill, 3 vj 

Rhubarb, ^ j 

Ginseng, § iss 

Canella, § iij 

Leaves of Cineraria, | iij 

Carbonate of Potash, > 

Salt of Wormwood, l^^ ^^ 

Chablis Wine, ft xij 

Macerate these substances in wine for fifteen days, 
then filter carefully, add to the liquor the alcoholic 
product of distillation, bottle it, and cork it tightly. 

Anti'Anaphrodisiac Marmalade. 
R Butter of Cacao, g iss 

Manna, S j 

Powdered Gum Arabic, > 

Anti-Anaphrodisiac Extract, 3 
Extract of Quinquina, 3 ij 

Extract of Saffron, 3 ss 

Laudanum, grs. xij 

Orange Flower Water, § ss 

Syrup of Balsam of Tolu, q. s. 

To make a Marmalade, or Paste. 



240 STERILITY CAUSES TREATMENT — • 

A spoonful of this to be taken morning and even- 
ing, the dose to be increased gradually to six spoon- 
fuls, taken during the day, two or three hours before 
or after eating. 

Cachunde^ Indian Pastilles. 

Powdered "Wood of Aloes, 5 ij grs. xxviij 

Powdered Red Sandal Wood, 3 jx grs. vj 

Powdered Yellow Sandal Wood, 3 ij 

Powdered Galanga, > 

T^ , . ^ , A . ^ aa grs. xxxij 

Powdered Calamus /Vromaticus, > 

Powdered Rhubarb, 3 j 

Powdered Wormwood, 5 ss 

Powdered Canella, 3 jv 

Powdered Mace, 3 ij 

Alcohol, § vj 

Make a Tincture, filter, evaporate to the consist- 
ence of syrup, and then add the following powders : 
Carbonate of Magnesia, 3 jv gr. 52 
Amber, 3 iij grs. x 

Musk, and Amber, aa S j 
Essence of Roses, 3 ss 

Vanilla Sugar, | ij 

Powdered Sugar, ft j 

Mucilage of Gum Tragacanth, q. s. 

To make pastilles of five grains weight. Take six 
daily — two in the morning, on empty stomach, and 
two before going to bed. The number may be 
increased to twelve daily. 



IN THE MALE AND FEMALE. 241 

Modified Pastilles* 

Powdered Ginseng, ) ** 

■XT .1, ^ aa f ss 

VanilJa, > 

Mace, ^ 

Nutmeg, }.aa 3 ijss 

Girofle, j 

White Sugar, lb j 

Essence of Canilla, gtt xij 

Essence of Amber, gtt viij 

Mucilage of Gum Tragacanth, g. s. 

To make pastilles of six grains each, eight or ten to 
be used daily. 

Indian WaJcaba, 
Canella powdered, 3 ss 
Cacao, § ss 

Sugar, § jv 

Vanilla Sugar, g ss 

Roucou dried, 3 j 

Mix and make a powder. 

Take a dessert-spoonful in a cup of myrtle tea, or 
water, before going to bed. 

Imperial Powder. 

Powder of Canella, 5 viij 

Powder of Ginger, 

Powder of Girofle, 

Powder of Galanga, 

Powder of Nutmeg, 

Musk, grs. vj 

Powdered Sugar, g viij 

Take like the preceding. 
21 



^aa 3 iss 



242 STERILITY CAUSES — TREATMENT 4 

Phosj^honc Freparation. 
• Essence of Rosemary, f j 

Phosphorus, grs. xij 

Place them in a flask, and hold over a lamp till the 
phosphorus has dissolved entirely ; then add, while 
the solution is warm, an ounce of oil of sweet 
almonds. — To rub the sexual organs. 

N. B. — The asterasic extracts, pills, and tinctures, 
are composed of substances which we have mentioned 
before, and are modified according to the patients. 

I here conclude the formulae which are most used 
in my practice. I have not stated the different modi- 
fications of which they are susceptible, because these 
vary according to the physiological conditions of the 
patients. 



CONTENTS. 



American Preface page 3 

French Preface 5 

Introduction , * 9 

CHAPTER I. 
Anatomy and Physiology of the Genital Organs in 
both sexes 15 

MALE GENITAL ORGANS. 

§ I. — Organs of Conjunction 16 

Penis, and Appendages , 16 

§ II. — Organs of Secretion 19 

1. Testicles 20 

2. Vasa Deferentia 21 

§ ni. — Organs of Emission 23 

1. Ejaculatory Ducts 23 

2. Verumontanum . , . . ^ , 24 

3. Urethra 24 

4. Ejaculatory Muscles 24 

§ IV. — Organs of Preservation 26 

1. Seminal Vesicles 26 

2. Ejaculatory Duets 29 

FEMALE GENITAL ORGANS. 

§ I. — Organs of Congress - 29 

"Vagina 29 



244 CONTENTS. 

§ II. — Organs of Secretion 31 

1. Ovaries , 31 

2. Fallopian Tubes 33 

§ III. — Organs of Preservation 34 

Utenis 34 

Generation 37 

1. Seminal Fluid 42 

2. Copulative Functions 47 

3. Organic Functions of Keprodaction 48 

CHAPTER II. 
Etiology and Therapeutics of Sterility 51 

DISEASES OF THE MALE GENITAL SYSTEM. 
§ I. — Diseases of Organs of Conjunction 51 

1. Absence of Penis 51 

2. Excessive Size of Penis ^53 

3. Small Size of Penis .54 

4. Deviations in Direction of Penis 54 

5. Duplicity of Penis 56 

6. Imperf oration of Prepuce and Glans 56 

7. Hypospadias 56 

8. Epispadias 73 

9. Phymosis 78 

10. Paraphymosis 78 

11. Deficiency of Prepuce 79 

12. Abnormal Length of Frenum of Penis 81 

13. Abnormal Shortness of Frenum 81 

14. Satyriasis 82 

15. Anaphrodisia 84 

Shampooing and Malaxation 103 

Influence of Cerebellum on Generation. 110 

§ II. — Diseases of Organs of Secretion 113 

1. Absence of Testicles 113 

2. Atrophy of Testicles 114 

3. Adhesion of Testicles to Suprapubic Ring » « . 114 



CONTENTS. 245 

4. Hydrocele. < . ... 115 

5. Sarcocele 115 

6. Spermatocele 116 

7. Ossification of Testicles 117 

8. Obstruction of Vasa Deferentia 1 17 

9. Dilatation and Relaxation of Vasa Deferentia 118 

10. Circocele .118 

§ ni. — Diseases of Organs of Emission 119 

1. Special Lesions of Prostate Gland 119 

2. Diseases of Verumontanum 123 

3. Diseases of Urethra 125 

4. Diseases of Muscles contributing to Emission of Semen. .127 
§ rV. — Diseases of Organs of Conservation 130 

CONSTITUTIONAL CAUSES OF STERILITY IN MALES. 
§ I. — Physiological Dispositions 131 

1 . Ages 131 

2. Temperaments , 134 

3. Idiosyncracies 136 

§ II. — Pathological Axterations v . . . 141 

Physiological Remarks on Sterility in Females.. 145 

DISEASES OF THE FEMALE GENITAL SYSTEM. 
§ I. — Diseases of Organs of Conjunction 147 

1. Excessive Length of the Clitoris 148 

2. Deviations in Formation of Nymphse 150 

3. Absence of Vagina 151 

4. Narrowness of Vagina 152 

5. Obliteration of Vagina , 153 

6. Deviations in Direction of Vagina 154 

7. Spasm of Vagina 156 

8. Polypi 157 

9. Vaginal Fistulse 157 

§ II. — Diseases of Organs of Secretion . , 160 

1. Absence of Ovaries 160 

2. Absence of Spermatic Arteries 160 

3. Inflammation of Ovaries 160 

21* 



246 CONTENTS'. 

4. Induration and Schirrous of Ovaries 161 

5. Osseous and Calcareous Change of Ovaries ^ 162 

6. Dropsy of Ovaries 163 

7. Absence or Alteration of Corpuscles of Ovaries 163 

8. Hernias of Ovaries 163 

§ III. — Diseases of Organs of Conservation 164 

1. Absence of Uterus 164 

2. Closing of Uterus 166 

3. Circa-Uterine Membrane 169 

4. Want of C avity and Atrophy of Uterus 170 

5. Leucorrhoea 177 

6. Amenorrhoea ... 178 

7. Menorrhagia ^w- 180 

8. Hysteria, Nymphomania, etc 181 

9. Anaphrodisia 182 

10. Tumors of Uterus 188 

1 1 . Schirrous and Cancer 188 

12. Extirpation of Neck of Uterus 190 

13. Deviations in Position of Uterus 193 

(1.) Descent 193 

(2.) Inversion of Uterus 195 

(3.) Anteversion, Retroversion, and Obliquity of Uterus. .196 
Diseases of the Fallopian Tubes 198 

CONSTITUTIONAL CAUSES OF STERILITY IN FEMALES. 
§ I. — Physiologicai. Dispositions , 201 

1. Ages 201 

2. Temperaments 202 

§ II. — Pathological Dispositions » 203 

CHAPTER III. 

Pharmacology applied to Cure of Sterility 205 

APHRODISIAC SUBSTANCES. 

§ I. — Vegetable Kingdom 207 

1. Summer Savory 207 



CONTENTS. 247 

2. Catnip » 208 

3. Mint 208 

(1.) Mentha Crispa ..208 

(2.) Peppermint 209 

4. Asparagus 209 

5. Cineraria Siberica 210 

6. Brasica Eruca 210 

7. Eiyngo 211 

8. Common Avens 211 

9. Actoea Racemosa 212 

10. Salep 212 

11. Root of John of Lopez 213 

12. Cor '-- Scoparius 214 

13. Japan Ginseng 214 

14. Truffles 215 

15. Alliaceoe 216 

16. Amomum Cardamomura 217 

17. Amomum Grana Paradisi 217 

18. Seeds of Vitex Agnus Castus 218 

19. Seeds of Cacao Theobrcma 218 

20. Vanilla 219 

21. Opium 221 

22. Balsam of Mecca 221 

23. Balsam of Tolu 221 

24. Balsam of Peru 222 

25. Balsam of Benzoin 222 

26. Cubebs 225 

§ II. — Animal Kingdom 226 

27. Cantharides 226 

28. Castoreum 227 

29. Ambergris 228 

30. Civet 228 

31. Musk 228 



248 CONTENTS. 

DIFFERENT PREPARATIONS USED EXTERNALLY FOR 
STERILITY. 

1. Asterasic Baths 231 

2. Asterasic Girdle 232 

3. Anti-Anaphrodisiac Liniments .333 

4. Compound Tincture of Benzoin 234 

5. Asterasic Pommades 235 

PREPARATIONS USED INTERNALLY FOR STERILITY. 

1. Royal Essence .236 

2. Oriental Essence 236 

3. Anti-Anaphrodisiac Syrup for Males 237 

4. Anti-Anaphrodisiac Syrup for Females 237 

5. Asterasic Pastilles , 238 

6. Tonic Asterasic Wine 239 

7. Anti-Anaphrodisiac Marmalade 239 

8. Cachunde, Indian Pastilles 240 

9. Modified Pastilles 241 

10. Indian Wakaba , 241 

11. Imperial Powder ^^ 241 

12. Phosphoric Preparation 242 



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